经皮肾镜钬激光碎石术对复杂性肾结石患者应激指标及肾功能的影响

Effect of percutaneous nephrolithotomy with holmium laser lithotripsy on stress response and renal function of patients with complex renal calculus

目的:探讨经皮肾镜钬激光碎石术对复杂性肾结石患者应激指标及肾功能的影响。方法:将90例复杂性肾结石患者随机分为观察组(n=45)和对照组(n=45),观察组患者采用经皮肾镜钬激光碎石术治疗,对照组患者采用肾切开取石术治疗;记录两组手术情况及术后并发症情况,分析手术前后两组患者血清皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)等应激指标和BUN、SCr、脂质运载蛋白(NGAL)等肾功能指标变化。结果:观察组手术时间、下床活动时间以及术后住院时间均小于对照组,差异有统计学意义(P<0.05)。术后1d,两组患者血清Cor、NE、ACTH水平均显著升高,且对照组显著高于观察组,差异有统计学意义(P<0.05)。术后1周及术后1个月,观察组患者血BUN、SCr以及NGAL水平显著低于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率显著低于对照组,而观察组结石清除率则明显高于对照组,差异有统计学意义(P<0.05)。结论:经皮肾镜钬激光碎石治疗复杂性肾结石的疗效显著,且能够有效降低患者机体应激反应,减轻肾功能损伤。

Objective:To investigate the effect of percutaneous nephrolithotomy with holmium laser lithotripsy on stress response and renal function of patients with complex renal calculus.Methods:Ninety patients with complex renal calculus were randomly divided into observation group(n=45)and control group(n=45).The patients in observation group underwent percutaneous nephrolithotomy with holmium laser lithotripsy,and those in control group were treated with open renal lithotomy.The operation time,intraoperative blood loss,and postoperative complications in two groups were recorded.The changes in cortisol(Cor),noradrenaline(NE),adrenocorticotrophic hormone(ACTH)and blood urea nitrogen(BUN),serum creatinine(SCr),neutrophil gelatinase-associated lipocalin(NGAL)levels in two groups before and after operation were analyzed.Results:The operative time,activity out of bed days and hospital stay in observation group were significantly shorter than those in control group(P<0.05).One day after operation,the serum Cor,NE,and ACTH levels in two groups were significantly increased as compared with those before operation,and those indexes in control group were significantly higher than in observation group(P<0.05).The serum BUN,SCr and NGAL levels in observation group at 1 st week and 1 st month after operation were significantly lower than those in control group(P<0.05).The incidence of postoperative complications was significantly lower,and the stone clearance rate was significantly higher in the observation group than in the control group(P<0.05).Conclusions:Percutaneous nephrolithotomy with holmium laser lithotripsy has precise curative effect in the treatment of complex renal calculus.It can reduce the stress response and kidney function injury.