超声引导下微通道经皮肾镜取石术治疗肾结石的疗效及对机体应激反应的影响  

Ultrasound-guided percutaneous nephrolithotomy with microchannel for the treatment of renal calculi and its effect on stress response

作　　者：杨小杰[1] 李友芳[1] 王茜 张栋[1] 雒启东[1] 张鹏[1] YANG Xiaojie;LI Youfang;WANG Qian;ZHANG Dong;LUO Qidong;ZHANG Peng(Department of Urology ,Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院泌尿外科,710004

出　　处：《疑难病杂志》2019年第5期477-481,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省自然科学基础研究计划项目(2012018JM7154)

摘　　要：目的观察超声引导下微通道经皮肾镜取石术治疗肾结石的疗效及对机体应激反应的影响,为肾结石的临床治疗提供参考。方法选择2016年1月—2018年7月西安交通大学第二附属医院泌尿外科收治的150例肾结石患者作为研究对象,按照随机数字表法分为对照组和观察组各75例。对照组患者给予标准通道经皮肾镜碎石术(sPCNL),观察组患者给予微通道经皮肾镜碎石术(mPCNL)。观察2组患者的手术相关指标、结石清除率、术后并发症和复发率差异,比较2组患者治疗前后尿液肾损伤分子1 (KIM-1)、肾功能以及氧化应激指标水平变化。结果观察组患者术中出血量明显低于对照组,手术时间长于对照组,结石清除率高于对照组,差异有统计学意义(t/P=10.603/<0.001,14. 832/<0.001,χ~2/P=12.354/0.000);手术后,2组患者尿液KIM-1均升高,且观察组高于对照组(t/P=32.541/<0.001),血清Cor、AD、NE水平均升高,且观察组升高低于对照组(t/P=20. 714/<0.001,24. 345/<0. 001,20. 895/<0.001);2组患者手术后血清GSH-Px、SOD水平均降低,且观察组降低优于对照组(t/P=4. 386/<0. 001,8. 163/<0.001), MDA水平均升高,且观察组升高优于对照组(t/P=3. 264/0.001)。2组患者并发症发生情况及复发率比较差异均无统计学意义(P>0.05)。结论 mPCNL治疗肾结石患者具有较高的结石清除率,且可以明显降低机体的应激反应,而sPCNL手术对肾功能损伤较小,临床医师可根据患者病情选择更为适合的治疗方案。Objective To observe the effect of ultrasound-guided percutaneous nephrolithotomy with microchannel on renal calculi and its effect on stress response, so as to provide reference for clinical treatment of renal calculi. Methods From January 2016 to July 2018, 150 patients with kidney stones admitted to the Urology Department of the Second Affiliated Hospital of Xi’an Jiaotong University were selected as the research objects. According to the random number table, they were divided into control group and observation group, 75 cases in each group. The control group was treated with standard channel percutaneous nephrolithotomy(sPCNL), while the observation group was treated with microchannel percutaneous nephrolithotomy(mPCNL). The operation related indexes, stone clearance rate, postoperative complications and recurrence rate of the two groups were observed. The changes of urine and kidney injury molecule 1( KIM-1), renal function and oxidative stress were compared between the two groups before and after treatment. Results The intraoperative blood loss of the observation group was significantly lower than that of the control group. The operation time was longer than that of the control group, and the stone clearance rate was higher than that of the control group. The difference was statistically significant(t/P = 10. 603/<0. 001,t/P = 14. 832/<0. 001).χ^2/P = 12. 354/0.000);After surgery. urine KIM-1 was elevated in both groups, and the observation group was higher than the control group(t/P =32. 541/<0.001), serum Cor, AD, NE levels elevated, and the observation group increased lower than those in the control group(t/P = 20. 714/<0.001, t/P = 24. 345/<0. 001, t/P =20. 895/<0. 001);two groups of patients after surgery serum GSH-Px, SOD The water level was lower, and the observation group was lower than the control group(t/P =4. 386/<0.001, t/P =8. 163/<0. 001), the MDA level was increased, and the observation group was superior to the control group(t/P = 3. 264/0.001). There was no significant difference in the

关 键 词：超声引导 经皮肾镜取石术 微通道 肾结石 应激反应 

分 类 号：R699.2[医药卫生—泌尿科学]