标准通道超声-气压弹道碎石术治疗复杂肾结石对患者肾功能及预后的影响研究  

The effect of standard channel ultrasonography-pneumatic lithotripsy on kidney function and prognosis of patients in the treatment of complex kidney calculi

作　　者：赵熊[1] 杨发武 Zhao Xiong;Yang Fawu(Department of Urology,Suixi County Hospital of Anhui Province,Huaibei 235100,China)

机构地区：[1]安徽省濉溪县医院泌尿外科,淮北235100

出　　处：《中国医师进修杂志》2023年第10期905-909,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨标准通道超声-气压弹道碎石术治疗复杂肾结石对患者肾功能及预后的影响。方法回顾性选择2017年10月至2020年9月安徽省濉溪县医院收治的60例复杂肾结石患者,其中29例患者采用标准通道超声-气压弹道碎石术(观察组),31例患者采用气压弹道碎石术(对照组)。比较两组围手术期指标、清石率、复发率及并发症发生率,比较两组手术前后肾功能及生命质量变化。结果观察组手术时间、术中出血量、术后血红蛋白(Hb)下降量、术后尿血时间和术后镇痛药使用次数均低于对照组[(80.86±16.95)min比(94.31±13.11)min、(60.52±9.17)ml比(69.34±10.06)ml、(8.58±2.05)g/L比(10.11±2.42)g/L、(3.02±1.09)d比(3.65±1.27)d、(4.59±1.62)次比(6.43±1.39)次],差异有统计学意义(P<0.05)。观察组术后4周肾功能相关指标尿N-乙酰-β-氨基葡萄糖苷酶、尿β2微球蛋白、血清中性粒细胞明胶酶相关载脂蛋白及血清肌酐水平低于对照组[(5.13±2.14)U/L比(7.08±2.35)U/L、(0.14±0.07)mg/L比(0.22±0.09)mg/L、(2.06±1.01)μg/L比(2.71±1.06)μg/L、(97.05±20.97)μmol/L比(110.64±20.32)μmol/L],差异有统计学意义(P<0.05)。观察组治疗后清石率高于对照组[93.10%(27/29)比70.97%(22/31)],复发率低于对照组[0比19.35%(6/31)],差异有统计学意义(χ^(2)=4.90、4.27,P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。观察组住院时间短于对照组[(5.54±2.06)d比(7.01±2.13)d],术后3、6个月生命质量量表评分高于对照组[(82.55±6.36)分比(78.98±5.32)分、(87.03±7.21)分比(83.46±6.05)分],差异有统计学意义(P<0.05)。结论标准通道超声-气压弹道碎石术能有效治疗复杂性肾结石,改善患者肾功能并促进手术恢复,且安全性较好。Objective To explore the effect of standard channel ultrasonography-pneumatic lithotripsy on kidney function and prognosis of patients in the treatment of complex kidney calculi.Methods A total of 60 patients with complex kidney calculi admitted to Suixi County Hospital of Anhui Province from October 2017 to September 2020 were selected and divided into the observation group(29 cases,received ultrasound-pneumatic lithotripsy operation)and the control group(31 cases,received pneumatic lithotripsy operation)according to different treatment methods.The perioperative indexes,stone clearing rate,recurrence rate,complication rate,the renal function changes and quality of life(QOL)changes before and after the operation were compared between the two groups.Results The operation time,intraoperative blood loss,postoperative decrease in hemoglobin(Hb),postoperative hematuria time and times of postoperative using analgesic in the observation group were lower than those in the control group:(80.86±16.95)min vs.(94.31±13.11)min,(60.52±9.17)ml vs.(69.34±10.06)ml,(8.58±2.05)g/L vs.(10.11±2.42)g/L,(3.02±1.09)d vs.(3.65±1.27)d,(4.59±1.62)times vs.(6.43±1.39)times,there were statistical differences(P<0.05).At 4 weeks post operation,the levels of renal function indexes urinary N-acetyl-glucosaminidase(NAG),urinaryβ2 microglobulin(β2-MG),serum neutrophilic gelatinase-associated apolipoprotein(NGAL),serum creatinine(SCr)in the observation group were lower than those in the control group:(5.13±2.14)U/L vs.(7.08±2.35)U/L,(0.14±0.07)mg/L vs.(0.22±0.09)mg/L,(2.06±1.01)μg/L vs.(2.71±1.06)μg/L,(97.05±20.97)μmol/L vs.(110.64±20.32)μmol/L,there were statistical differences(P<0.05).The clearing stone rate in the observation group was higher than that in the control group,and recurrence rate was lower than that in the control group:93.10%(27/29)vs.70.97%(22/31),0 vs.19.35%(6/31),there were statistical differences(χ^(2)=4.90,4.27,P<0.05).The incidence of complication in the two groups had no significant difference(P>0.05

关 键 词：碎石术 肾结石 手术后并发症 预后 

分 类 号：R699.2[医药卫生—泌尿科学]