PCNL联合FU治疗肾结石对肾脏的损伤作用
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摘要
目的:探讨经皮肾镜(PCNL)联合输尿管软镜(FU)治疗肾结石对患者肾功能及炎性因子的影响。方法:选取我院治疗的肾结石患者80例进行回顾性分析,收集时间2017年1-8月,根据治疗方法分为研究组(采用PCNL联合FU)和对照组(采用经皮肾镜碎石术)各40例,检测两组患者手术前、手术后24,48,72 h的尿液中肾损伤分子-1(KIM-1)、β2微球蛋白(β2-MG)、γ-谷氨酰胺转移酶(γ-GT)、血清中半胱氨酸蛋白酶抑制剂C(Cys-C)、中性粒细胞明胶海绵酶相关脂质运载蛋白(NAGL)、超氧化物歧化酶(SOD)、丙二醛(MDA)、一氧化氮(NO)、内皮素(ET-1)的变化。结果:研究组患者的结石清除率95. 00%显著高于对照组的80. 00%(P<0. 05);在术后24,48,72 h,两组患者的尿液中的KIM-1、β2-MG、γ-GT水平较术前均显著增高(P<0. 05),两组患者在各个时间点的KIM-1、β2-MG、γ-GT水平比较差异均无统计学意义(P>0. 05);两组患者在术后24,48,72 h的外周血中的Cys-C、NAGL、MDA、NO、ET-1水平较术前均显著增高(P<0. 05),SOD水平较术前均显著的降低(P<0. 05),两组患者在各个时间点Cys-C、NAGL、SOD、MDA、NO、ET-1水平比较差异均无统计学意义(P>0. 05)。结论:PCNL联合FU治疗的肾结石患者效果较好,相对于经皮肾镜碎石术并不会增大对肾脏的损害,并且大部分损害在术后48 h内逐渐恢复。
Objective: To investigate the effect of percutaneous nephrolithotomy(PCNL) combined with ureteroscopic(FU) treatment of renal calculi on renal function and inflammatory factors.Methods: Eighty cases of renal calculi treated in our hospital were retrospectively analyzed from January 2017 to August2017. The patients were divided into study group( treatment using PCNL combined with FU group)and control group(treatment using percutaneous nephrolithotripsy) with 40 cases of each group, then urine levels of KIM-1, β2-microglobulin(MGM) and γ-GT were assayed before operation, 24 h, 48 h and 72 h after surgery, meanwhile, the serum Cys-C, NAGL, SOD, malondialdehyde(MDA), nitric oxide(NO) and endothelin(ET - 1) were also measured.Results: The stone clearance rate in study group was 95. 00%, which was significantly higher than that in control group(80. 00%, P<0. 05).KIM-1 and β2 in urine were measured 24, 48, and 72 h after operation in both groups(P<0. 05), but there were no significant differences between the two groups at all time points(P>0. 05). The levels of Cys-C, NAGL, MDA, NO, and ET-1 in the peripheral blood of the two groups 24, 48, 72 h after surgery were significantly higher than those before the operation(P<0. 05). There was no signifi-cant differences in the levels of Cys-C, NAGL, SOD, MDA, NO and ET-1 between the two groups at all time points.Conclusion: Compared with percutaneous nephrolithotomy, treatment of PCNL combined with FU for renal stones patients has better results, does not increase the damage to the kid-neys, and most of the damage is gradually restored within 48 h after surgery.
Objective: To investigate the effect of percutaneous nephrolithotomy(PCNL) combined with ureteroscopic(FU) treatment of renal calculi on renal function and inflammatory factors.Methods: Eighty cases of renal calculi treated in our hospital were retrospectively analyzed from January 2017 to August2017. The patients were divided into study group( treatment using PCNL combined with FU group)and control group(treatment using percutaneous nephrolithotripsy) with 40 cases of each group, then urine levels of KIM-1, β2-microglobulin(MGM) and γ-GT were assayed before operation, 24 h, 48 h and 72 h after surgery, meanwhile, the serum Cys-C, NAGL, SOD, malondialdehyde(MDA), nitric oxide(NO) and endothelin(ET - 1) were also measured.Results: The stone clearance rate in study group was 95. 00%, which was significantly higher than that in control group(80. 00%, P<0. 05).KIM-1 and β2 in urine were measured 24, 48, and 72 h after operation in both groups(P<0. 05), but there were no significant differences between the two groups at all time points(P>0. 05). The levels of Cys-C, NAGL, MDA, NO, and ET-1 in the peripheral blood of the two groups 24, 48, 72 h after surgery were significantly higher than those before the operation(P<0. 05). There was no signifi-cant differences in the levels of Cys-C, NAGL, SOD, MDA, NO and ET-1 between the two groups at all time points.Conclusion: Compared with percutaneous nephrolithotomy, treatment of PCNL combined with FU for renal stones patients has better results, does not increase the damage to the kid-neys, and most of the damage is gradually restored within 48 h after surgery.
引文
[1]吕春燕,时淑燕,杨玲,等. 842例肾手术患者临床病理及流行病学研究[J].西部医学,2016,28(2):208-211.Lv CY, Shi SY, Yang L, et al. Retrospective study of clinical, pathological, and epidemiological characters in842 cases of kidney operation diseases in a regional hos-pital[J]. Medical Journal of West China, 2016, 28(2):208-211.
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[4]万正华,陈斌,王雪刚,等.电子输尿管软镜与组合式输尿管软镜下钬激光碎石治疗肾下盏结石的疗效分析[J].中国内镜杂志,2017,23(9):36-41.Wan ZH, Chen B, Wang XG, et al. Analysis of the ef-ficacy of electronic ureteroscopy and combined uretero-scopic holmium laser lithotripsy for the treatment of lower renal calculi[J]. Chinese Endoscope Journal,2017,23(9):36-41.
[5]梁磊,杨春生,孟繁林,等.孤立肾结石的两种微创治疗方法比较[J].实用医学杂志, 2015, 31(15):2 535-2 538.Liang L, Yang CS, Meng FL, et al. Comparison of two minimally invasive treatments for solitary kidney calculi[J]. Journal of Practical Medicine, 2015, 31(15):2 535-2 538.
[6]范波,丁琪,范志江,等.新型组合式输尿管软镜联合钬激光治疗肾结石的疗效[J].实用医学杂志,2016,32(19):3 216-3 219.Fan B, Ding Q, Fan ZJ, et al. Efficacy of new flexible ureteroscopy combined with holmium laser in the treat-ment of renal calculi[J]. Practical Medicine Journal,2016,32(19):3 216-3 219.
[7]邓青富,姜睿,裴利军,等.电子输尿管软镜与微创经皮肾镜碎石术治疗肾结石的比较[J].实用医学杂志,2016,32(5):721-723.Deng QF, Jiang R, Pei LJ, et al. Comparison of elec-tronic ureteroscopy and minimally invasive percutane-ous nephrolithotripsy for renal calculi[J]. Practical Medi-cal Journal, 2016,32(5):721-723.
[8]栾海霞,袁慧,贺建勋,等.尿NGAL不同时点浓度变化在心脏术后急性肾损伤的早期诊断价值[J].首都医科大学学报,2015,36(4):592-596.Luan HX, Yuan H, He JX, et al. The early diagnostic value of NGAL non simultaneous point concentration changes in acute renal injury after cardiac surgery[J].Journal of Capital Medical University, 2015, 36(4):592-596.
[9] Dale J, Kaplan AG, Radvak D, et al. Evaluation of a novel single-use flexible ureteroscope[J]. J Endourol,2017:doi:10. 1089/end. 2016. 0237.[Epub ahead of print].
[10]苏学锋,黄庭芳,陈宝琨.标准单通道、双通道PCNL对肾结石患者肾血流动力学的影响[J].医学临床研究,2015,32(12):2 317-2 320.Su XF, Huang TF, Chen BK. The effect of standard single channel, double channel PCNL on renal hemody-namics in patients with renal calculi[J]. Medical Clinical Study, 2015,32(12):2 317-2 320.
[11] Proietti S, Sortino G, Giannantoni A, et al. Single-ses-sion supine bilateral percutaneous nephrolithotomy[J].Urology, 2015,85(2):304.
[12] Shah K, Monga M, Knudsen B. Prospective random-ized trial comparing 2 flexible digital ureteroscopes:AC-MI/Olympus invisio DUR-D and Olympus URF-V[J].Urology, 2015,85(6):1 267-1 271.
[13] Hamamoto S, Yasui T, Okada A, et al. Efficacy of en-doscopic combined intrarenal surgery in the prone split-leg position for staghorn calculi[J]. J Endourol, 2015,29(1):19-24.
[14]丁琪,范志江,李锋,等.输尿管软镜与经皮肾镜治疗肾结石的对照研究[J].实用医学杂志,2016,32(13):2 193-2 195.Ding Q, Fan ZH, Li F, et al. A comparative study of flexible ureteroscopy and percutaneous nephrolithotomy in the treatment of renal calculi[J]. Journal of Practical Medicine, 2016,32(13):2 193-2 195.
[15]薛萍,钟润芝.尿肾损伤分子-1对脓毒症急性肾损伤诊断价值分析[J].现代仪器与医疗,2015,21(3):74-76.Xue P, Zhong RZ. Diagnostic value of urine kidney in-jury molecule-1 for sepsis acute kidney injury[J]. Mod-ern Instrument and Medical Treatment, 2015,21(3):74-76.
[16] Kokura K, Kuromi Y, Endo T, et al. A kidney injury mol-ecule-1(Kim-1)gene reporter in a mouse artificial chro-mosome:the responsiveness to cisplatin toxicity in immor-talized mouse kidney S3 cells[J]. J Gene Med, 2016,18(10):273-281.
[17] Yang R, Fu S, Zhao L, et al. Quantitation of circulating GDF-11 andβ2-MG in aged patients with age-related im-pairment in cognitive function[J]. Clin Sci(Lond), 2017,131(15):1 895-1 904.
[18] Dominici R, Finazzi D, Polito L, et al. Comparison ofβ2-microglobulin serum level between Alzheimer's patients,cognitive healthy and mild cognitive impaired individuals[J]. Biomarkers, 2018, 23(6):1-17.
[19]李宏良,张东军,孙志坚.肝病患者血清前白蛋白、载脂蛋白-A1、胆碱酯酶、γ-谷氨酰转肽酶、凝血酶原时间、总胆汁酸的变化及临床意义[J].中华传染病杂志, 2016,34(3):182-185.Li HL, Zhang DJ, Sun ZJ. Changes of serum prealbumin,apolipoprotein-A1, cholinesterase,γ-glutamyltranspepti-dase, prothrombin time, total bile acid in patients with liv-er disease and its clinical significance[J]. Chinese Jour-nal of Infectious Diseases, 2016,34(3):182-185.
[20]赵中伟,张晓波,陈雄,等.经皮肾镜联合输尿管软镜治疗肾结石对老年患者肾功能的影响[J].中南大学学报:医学版,2015,40(3):276-280.Zhao ZW, Zhang XB, Chen X, et al. Effect of percutane-ous nephrostolithotomy combinedwith flexible ureterosco-py on renal functionin elderly patients with renal calculi[J]. Journal of Central South University(Medical Scienc-es), 2015,40(3):276-280.
[2]李毅,陈刚,文爽,等.输尿管软镜钬激光碎石术治疗长径≥2 cm的肾结石68例临床分析[J].第三军医大学学报,2016,38(13):1 547-1 551.Li Y, Chen G, Wen S, et al. Ureteroscopic lithotripsy with holmium laser lithotripsy for the treatment of renal calculi with long diameter more than 2 cm[J]. Journal of Third Military Medical University, 2016,38(13):1 547-1 551.
[3]廖国栋,俞蔚文,章越龙,等.超微经皮肾镜和输尿管软镜在治疗肾结石中的感染控制及疗效的对比研究[J].中华医院感染学杂志,2017,27(11):2 543-2 546.Liao GD, Yu YW, Zhang YL, et al. A comparative study of the infection control and efficacy of ultramicro percutaneous nephroscope and ureteroscopy in the treat-ment of renal calculi[J]. Chinese Journal of Infection,2017,27(11):2 543-2 546.
[4]万正华,陈斌,王雪刚,等.电子输尿管软镜与组合式输尿管软镜下钬激光碎石治疗肾下盏结石的疗效分析[J].中国内镜杂志,2017,23(9):36-41.Wan ZH, Chen B, Wang XG, et al. Analysis of the ef-ficacy of electronic ureteroscopy and combined uretero-scopic holmium laser lithotripsy for the treatment of lower renal calculi[J]. Chinese Endoscope Journal,2017,23(9):36-41.
[5]梁磊,杨春生,孟繁林,等.孤立肾结石的两种微创治疗方法比较[J].实用医学杂志, 2015, 31(15):2 535-2 538.Liang L, Yang CS, Meng FL, et al. Comparison of two minimally invasive treatments for solitary kidney calculi[J]. Journal of Practical Medicine, 2015, 31(15):2 535-2 538.
[6]范波,丁琪,范志江,等.新型组合式输尿管软镜联合钬激光治疗肾结石的疗效[J].实用医学杂志,2016,32(19):3 216-3 219.Fan B, Ding Q, Fan ZJ, et al. Efficacy of new flexible ureteroscopy combined with holmium laser in the treat-ment of renal calculi[J]. Practical Medicine Journal,2016,32(19):3 216-3 219.
[7]邓青富,姜睿,裴利军,等.电子输尿管软镜与微创经皮肾镜碎石术治疗肾结石的比较[J].实用医学杂志,2016,32(5):721-723.Deng QF, Jiang R, Pei LJ, et al. Comparison of elec-tronic ureteroscopy and minimally invasive percutane-ous nephrolithotripsy for renal calculi[J]. Practical Medi-cal Journal, 2016,32(5):721-723.
[8]栾海霞,袁慧,贺建勋,等.尿NGAL不同时点浓度变化在心脏术后急性肾损伤的早期诊断价值[J].首都医科大学学报,2015,36(4):592-596.Luan HX, Yuan H, He JX, et al. The early diagnostic value of NGAL non simultaneous point concentration changes in acute renal injury after cardiac surgery[J].Journal of Capital Medical University, 2015, 36(4):592-596.
[9] Dale J, Kaplan AG, Radvak D, et al. Evaluation of a novel single-use flexible ureteroscope[J]. J Endourol,2017:doi:10. 1089/end. 2016. 0237.[Epub ahead of print].
[10]苏学锋,黄庭芳,陈宝琨.标准单通道、双通道PCNL对肾结石患者肾血流动力学的影响[J].医学临床研究,2015,32(12):2 317-2 320.Su XF, Huang TF, Chen BK. The effect of standard single channel, double channel PCNL on renal hemody-namics in patients with renal calculi[J]. Medical Clinical Study, 2015,32(12):2 317-2 320.
[11] Proietti S, Sortino G, Giannantoni A, et al. Single-ses-sion supine bilateral percutaneous nephrolithotomy[J].Urology, 2015,85(2):304.
[12] Shah K, Monga M, Knudsen B. Prospective random-ized trial comparing 2 flexible digital ureteroscopes:AC-MI/Olympus invisio DUR-D and Olympus URF-V[J].Urology, 2015,85(6):1 267-1 271.
[13] Hamamoto S, Yasui T, Okada A, et al. Efficacy of en-doscopic combined intrarenal surgery in the prone split-leg position for staghorn calculi[J]. J Endourol, 2015,29(1):19-24.
[14]丁琪,范志江,李锋,等.输尿管软镜与经皮肾镜治疗肾结石的对照研究[J].实用医学杂志,2016,32(13):2 193-2 195.Ding Q, Fan ZH, Li F, et al. A comparative study of flexible ureteroscopy and percutaneous nephrolithotomy in the treatment of renal calculi[J]. Journal of Practical Medicine, 2016,32(13):2 193-2 195.
[15]薛萍,钟润芝.尿肾损伤分子-1对脓毒症急性肾损伤诊断价值分析[J].现代仪器与医疗,2015,21(3):74-76.Xue P, Zhong RZ. Diagnostic value of urine kidney in-jury molecule-1 for sepsis acute kidney injury[J]. Mod-ern Instrument and Medical Treatment, 2015,21(3):74-76.
[16] Kokura K, Kuromi Y, Endo T, et al. A kidney injury mol-ecule-1(Kim-1)gene reporter in a mouse artificial chro-mosome:the responsiveness to cisplatin toxicity in immor-talized mouse kidney S3 cells[J]. J Gene Med, 2016,18(10):273-281.
[17] Yang R, Fu S, Zhao L, et al. Quantitation of circulating GDF-11 andβ2-MG in aged patients with age-related im-pairment in cognitive function[J]. Clin Sci(Lond), 2017,131(15):1 895-1 904.
[18] Dominici R, Finazzi D, Polito L, et al. Comparison ofβ2-microglobulin serum level between Alzheimer's patients,cognitive healthy and mild cognitive impaired individuals[J]. Biomarkers, 2018, 23(6):1-17.
[19]李宏良,张东军,孙志坚.肝病患者血清前白蛋白、载脂蛋白-A1、胆碱酯酶、γ-谷氨酰转肽酶、凝血酶原时间、总胆汁酸的变化及临床意义[J].中华传染病杂志, 2016,34(3):182-185.Li HL, Zhang DJ, Sun ZJ. Changes of serum prealbumin,apolipoprotein-A1, cholinesterase,γ-glutamyltranspepti-dase, prothrombin time, total bile acid in patients with liv-er disease and its clinical significance[J]. Chinese Jour-nal of Infectious Diseases, 2016,34(3):182-185.
[20]赵中伟,张晓波,陈雄,等.经皮肾镜联合输尿管软镜治疗肾结石对老年患者肾功能的影响[J].中南大学学报:医学版,2015,40(3):276-280.Zhao ZW, Zhang XB, Chen X, et al. Effect of percutane-ous nephrostolithotomy combinedwith flexible ureterosco-py on renal functionin elderly patients with renal calculi[J]. Journal of Central South University(Medical Scienc-es), 2015,40(3):276-280.