孤立肾结石患者经皮肾镜取石术后的肾功能变化及围手术期风险因素研究  

Impact of minimally invasive percutaneous nephrolithotripsy on renal function of solitarykidney and perioperative risk factors

作　　者：黄春泉 安凌春 于世超 丁宁 

机构地区：[1]东莞康华医院泌尿外科,广东东莞523080 [2]东莞康华医院肾内科,广东东莞523080

出　　处：《新疆医科大学学报》2017年第8期1020-1024,共5页Journal of Xinjiang Medical University

基　　金：2015年广东省东莞市科技计划医疗卫生类科研一般项目(2015105101027)

摘　　要：目的研究经皮肾镜术治疗后的孤立肾结石患者术后肾功能变化以及主要的风险因素。方法选择2011年12月-2016年12月在广东省东莞市东莞康华医院行经皮肾镜术治疗的肾结石患者54例。以根据中国人实际情况改良后的肾病膳食公式(MDRD)对肾小球滤过率(GFR)进行估算。并以GFR的变化作为皮肾镜手术前、后的肾功能评价指标。结果所有患者结石清除率为85.18%(46/54)。根据GFR的统计显示,术后1d的GFR水平略低于术前,差异无统计学意义(P>0.05)。术后3d开始逐渐恢复至术前水平,在术后30d时GFR水平趋于稳定。不同年龄、不同性别、无尿路感染、不合并高血压、无蛋白尿、肾功能正常和肾功能不全亚组术后与术前GFR水平基本一致。合并高血压组、尿路感染亚组和蛋白尿亚组术后1d的GFR水平均明显低于术前水平,术后3d和30d的GFR水平明显高于术前水平。患者经皮肾镜术治疗后的肾功能危险因素有合并蛋白尿(B=1.902,OR=4.744)、尿路感染(B=1.612,OR=5.248)以及合并高血压(B=1.495,OR=3.728)。结论对于通过经皮肾镜术进行治疗的孤立肾结石患者术前不存在高血压、蛋白尿以及尿路感染等情况下,手术后肾功能稳定的概率较高,反之患者术后肾功能出现恶化的情况较多。Objective To study the factors of percutaneous nephrolithotomy treatment of postoperative renal function after solitary kidney stone patients. Methods Selected 54 cases of patients with solitary kid-ney stones and treated by percutaneous nephrolithotomy during December 2011 to December 2016 in Dong-guan Kanghua Hospital. The estimated glomerular filtration rate （GFR） was calculated by modified modi-fication of diet in renal disease （MDRD） equation for Chinese patients, and the MDRD equation for Chinese patients was generally regarded as an important method for the determination of GFR change in preoperative and postoperative renal function. Results The stone-free rat was 85.18% （4 6 /5 4 ） .The mean GFR reduced transiently on the first day after surgery, and the difference between the GFR of baseline lev-el and first day after surgery was not statistically significant （P〉0.05 ） . The GFR level began to gradually return to baseline levels on the third day postoperatively, and tend to be stable on the thirtieth days after postoperatively. The age, gender, without urinary road infection, without proteinuria, without hyperten-sion, the normal versus impaired renal function were not the factors of GFR changing after mPCNL. And the proteinuria （B =1.902, OR =4 .7 4 4 ）, urinary road infection （B =1.612, OR =5.248） and hypertension （B=1.495, OR =3.728） were the risk factors of solitary kidney stones. Conclusion For the first treated by percutaneous nephrolithotomy surgery surgery solitary kidney stone patients with renal cortical thick-ness thicker, hypertension, proteinuria, and urinary tract infections absence of preoperative renal function after surgery, the higher the probability of stable or improved situation, whereas postoperative renal func-tion in patients deteriorate more.

关 键 词：孤立肾结石 经皮肾镜术 肾功能 

分 类 号：R692.4[医药卫生—泌尿科学]