输尿管上段结石微通道经皮肾镜和经尿道输尿管软镜钬激光碎石术对患者肾功能、血流动力学及血气指标的影响  

The effects of mini-percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy on renal function,hemodynamics,and blood gas indexes in patients with upper ureteral calculi

作　　者：古月 魏仁波[1] 严沁 席翔[1] GU Yue;WEI Ren-bo;YAN Qin;XI Xiang(Department of Urology, Chengdu Third People′s Hospital, Chengdu 610000, China)

机构地区：[1]成都市第三人民医院泌尿外科,四川成都610000

出　　处：《实用医院临床杂志》2022年第4期64-67,共4页Practical Journal of Clinical Medicine

基　　金：四川省卫生健康委员会科研基金资助项目(编号18PJ461)。

摘　　要：目的探讨输尿管上段结石微通道经皮肾镜取石术(MPCNL)和经尿道输尿管软镜钬激光碎石术(FURL)对患者肾功能、血流动力学及血气指标的影响。方法选取我院收治的120例输尿管上段结石患者,按随机数表法分为观察组59例与对照组61例。观察组给予FURL治疗,对照组给予MPCNL治疗。观察两组手术时间、术中出血量、住院时间及术后1个月结石清除率,并比较两组术前、术后肾功能指标尿素氮(BUN)、肌酐(Cr)、血流动力学指标中心静脉压(CVP)、心率(HR)、平均动脉压(MAP)及血气指标pH值、碱剩余(BE)、Na^(+)、K^(+)。结果观察组手术时间、住院时间短于对照组,术中出血量少于对照组(P<0.05);对照组术后1个月结石清除率高于观察组(P<0.05);两组术后BUN、Cr、CVP、MAP均较术前增高,pH、BE、K^(+)较术前降低(P<0.05)。结论输尿管上段结石患者采取MPCNL和FURL治疗对患者的血流动力学和血气指标影响均较小,前者结石清除率更高,后者手术时间及住院时间短,术中出血量少,对肾功能影响更小,临床需以患者具体情况为依据进行术式选择。Objective To investigate the effects of mini-percutaneous nephrolithotomy(MPCNL)and flexible ureteroscopic lithotripsy(FURL)on renal function,hemodynamics,and blood gas indexes in patients with upper ureteral calculi.Methods A total of 120 patients with upper ureteral calculi in our hospital were selected.The patients were divided into an observation group(n=59)and a control group(n=61)using random number table method.The observation group was treated with FURL,while the control group was treated with MPCNL.Operation time,intraoperative blood loss,hospitalization time,and stone clearance rate after 1 month of surgery were observed.Renal function indexes such as blood urea nitrogen(BUN)and creatinine(Cr),hemodynamics indexes such as central venous pressure(CVP),heart rate(HR),and mean arterial pressure(MAP)and blood gas indexes such as PH value,base excess(BE),Na^(+),and K^(+)were compared between the two groups before and after surgery.Results The operation time and hospitalization time were shorter and intraoperative blood loss was less in the observation group than those in the control group(P<0.05).The stone clearance rate in the control group after 1 month of surgery was higher than that in the observation group(P<0.05).After surgery,BUN,Cr,CVP and MAP were increased(P<0.05),while PH,BE and K+were decreased in both groups(P<0.05).Conclusion Both MPCNL and FURL have little influence on hemodynamics and blood gas indexes in patients with upper ureteral calculi.MPCNL can achieve a higher stone clearance rate,and FURL has characteristics of shorter operation time and hospitalization time,less intraoperative blood loss and less influence on renal function.Clinically,a surgical method should be selected based on the patient’s conditions.

关 键 词：输尿管结石 微通道 经皮肾镜取石术 经尿道输尿管软镜钬激光碎石术 肾功能 

分 类 号：R693.4[医药卫生—泌尿科学]