mPCNL与RIRS对直径>2cm肾结石患者肾功能及氧化应激指标的影响  

Effects of mPCNL and RIRS on Renal Function and Oxidative Stress Indexes in Patients with Kidney Stones > 2 cm in Diameter

作　　者：郝强 焦宗久[2] 牛忠涛 石丽佳 张淑敬 HAO Qiang;JIAO Zongjiu;NIU Zhongtao;SHI Lijia;ZHANG Shujing(Department of Urology,the Second Affiliated Hospital of Xingtai Medical College,Xingtai,Hebei 054000,China;Department of Hematology,Xingtai People's Hospital,Xingtai,Hebei 054001,China)

机构地区：[1]邢台医学高等专科学校第二附属医院泌尿外科,河北邢台054000 [2]邢台市人民医院血液科,河北邢台054001

出　　处：《临床误诊误治》2023年第6期103-107,共5页Clinical Misdiagnosis & Mistherapy

基　　金：邢台市科技计划项目(2021ZC182)。

摘　　要：目的 探讨微通道经皮肾镜取石术(mPCNL)与逆行输尿管软镜钬激光碎石术(RIRS)对直径>2 cm肾结石患者肾功能及氧化应激指标的影响。方法 选取2019年8月—2022年1月收治的182例直径>2 cm肾结石为研究对象,根据手术方式不同分为RIRS组和mPCNL组,每组91例。统计2组围术期指标、并发症以及手术前后肾功能指标[血清β2-微球蛋白(β2-MG)、血尿素(BUN)及尿肾损伤分子-1(KIM-1)]、氧化应激指标[血清丙二醛(MDA)、超氧化物歧化酶(SOD)]。结果 mPCNL组一期结石清除率为90.11%(82/91)高于RIRS组76.92%(70/91),手术时间短于RIRS组(P<0.05)。术后24 h, 2组血清β2-MG、BUN及尿KIM-1水平高于术前,且mPCNL组高于RIRS组(P<0.05);术后3个月,2组血清β2-MG、BUN及尿KIM-1水平均低于术前(P<0.05)。术后24 h, 2组血清MDA水平高于术前,SOD水平低于术前(P<0.05)。2组并发症总发生率比较差异无统计学意义(P>0.05)。结论 mPCNL与RIRS均为治疗直径>2 cm肾结石的有效手段,前者更有利于提高一期结石清除率,缩短手术时间。Objective To investigate the effects of microchannel percutaneous nephrolithotomy(mPCNL)and retrograde ureteroscopic intrarenal surgery(RIRS)with holmium laser lithotripsy on renal function and oxidative stress indexes in patients with kidney stones>2 cm in diameter.Methods A total of 182 patients with kidney stones>2 cm in diameter admitted from August 2019 to January 2022 were selected as the research subjects and divided into RIRS group(n=91)and mPCNL group(n=91)according to different surgical methods.Perioperative indexes,complications,renal function indexes[serumβ2-microglobulin(β2-MG),blood urea nitrogen(BUN)and urinary kidney injury molecule-1(KIM-1)],oxidative stress indexes[serum malondialdehyde(MDA),superoxide dismutase(SOD)]before and after operation were analyzed.Results The first-stage stone clearance rate in mPCNL group was higher than that in RIRS group[90.11%(82/91)vs.76.92%(70/91)],and the duration of operation was shorter than that in RIRS group(P<0.05).At 24 h after operation,serumβ2-MG,BUN and urine KIM-1 levels in the two groups were higher than those before operation,and the above indicators in mPCNL group were higher than those in RIRS group(P<0.05).At 3 months after operation,serumβ2-MG,BUN and urine KIM-1 levels in the two groups were lower than those before operation(P<0.05).At 24 h after operation,the serum MDA level in the two groups was higher than that before operation,while the SOD level was lower than that before operation(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion mPCNL and RIRS are both effective methods for the treatment of kidney stones>2 cm in diameter,and the former is more conductive to improving the first-stage stone clearance rate and shortening the duration of operation.

关 键 词：肾结石 微通道经皮肾镜取石术 逆行输尿管软镜钬激光碎石术 β2-微球蛋白 血尿素 肾损伤分子-1 丙二醛 超氧化物歧化酶 

分 类 号：R692.4[医药卫生—泌尿科学]