输尿管软镜、体外冲击波碎石治疗肾结石对老年性患者肾功能的影响

刘昌明; 翁吴斌; 李国敏; 林立姮

doi:10.13201/j.issn.1001-1420.2019.12.007

输尿管软镜、体外冲击波碎石治疗肾结石对老年性患者肾功能的影响

- 福建医科大学附属闽东医院泌尿外科(福建福安, 355000)
基金项目:
宁德市指导性科技计划项目（编号20160148）

详细信息

通讯作者: 刘昌明,E-mail:mdyylcm@163.com

中图分类号: R692.4

收稿日期: 2019-09-27

Effect of ureteroscopy and extracorporeal shock wave lithotripsy on renal function in elderly patients with renal calculi

- Department of Urology, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian, 355000, China

More Information

Corresponding author: LIU Changming, E-mail: mdyylcm@163.com

Received Date: 27 September 2019

摘要

摘要: 目的：探讨输尿管软镜碎石术（URS）、体外冲击波碎石术（ESWL）治疗肾结石对老年性患者肾功能的影响，并比较2种手术方式对肾功能的损害程度。方法：选取2016年6月~2018年5月在我院治疗的老年性肾结石患者80例，随机分成URS组和ESWL组，每组各40例。收集两组患者术前2 h及术后2、6、12、24、48、72 h血、尿标本，用ELISA法检测血中性粒细胞明胶酶相关载脂蛋白（NGAL）、半胱氨酸蛋白酶抑制剂C（Cys-C）及尿液肾损伤分子-1（KIM-1）的浓度，比较两组患者手术前后各指标的变化情况。结果：URS组中血NGAL及尿KIM-1浓度术后2 h内均出现明显升高，且达到高峰，与术前2 h及术后6 h比较差异均有统计学意义（P<0.05）；术后6 h开始逐渐下降，血NGAL于术后72 h未降至术前水平，与术前比较差异有统计学意义（P<0.05），而尿KIM-1于术后72 h基本降至术前水平，与术前比较差异无统计学意义；血Cys-C浓度术后2 h开始升高，于术后24 h达到高峰，与术后12、48 h比较差异有统计学意义（P<0.05），术后72 h仍未降至术前水平，与术前比较差异有统计学意义（P<0.05）。ESWL组中血NGAL及尿KIM-1浓度均于术后2 h开始升高，于术后6 h达到高峰，与术后2、12 h比较差异有统计学意义（P<0.05），随后浓度开始下降，于术后72 h降至术前水平，与术前2 h比较差异无统计学意义；血Cys-C浓度术后2 h开始升高，其高峰出现在术后48 h，与术后24、72 h比较差异有统计学意义（P<0.05），术后72 h其浓度与术前比较差异有统计学意义（P<0.05）。结论：URS和ESWL均对老年性患者早期肾功能产生损害，主要体现在对肾小管和肾小球的损伤，但造成的损害是可逆的。这2种手术方式中肾小管的损伤及恢复时间均早于肾小球。对于治疗<2 cm的结石，URS和ESWL 2种手术方式对老年患者肾功能的影响差异不大，但行ESWL对老年性患者肾小管的损伤及恢复时间均优于URS。
- 输尿管软镜碎石术 /
- 体外冲击波碎石术 /
- 肾结石 /
- 早期肾功能 /
- 老年患者
Abstract: Objective: To investigate the effect of ureteroscope(URS) and extracorporeal shock wave lithotripsy(ESWL) on renal function in elderly patients with renal calculi, and compare the degree of damage to renal function between the two surgical methods. Method: From June 2016 to May 2018, eighty patients with senile renal stones treated in our hospital were selected. They used URS and ESWL to treat kidney stones. Their blood and urine samples were collected 2 h before surgery and 2, 6, 12, 24, 48, 72 h after surgery. The concentrations of blood NGAL, Cys-C and urinary KIM-1 were measured by ELISA, and the changes of various indexes before and after surgery were compared between the two groups. Result: The blood NGAL and urinary KIM-1 concentrations in the URS group increased significantly within 2 h after operation, and reached the peak, which was significantly different from the preoperative and postoperative 6 h data(P<0.05). They started to fall from postoperative 6 h. Blood NGAL did not decrease to preoperative level 72 h after surgery(P<0.05 compared with preoperation), while urinary KIM-1 decreased to preoperative level at 72 h after surgery(P>0.05 compared with preoperation). The blood Cys-C concentration began to increase at 2 h after operation and reached a peak at 24 h after operation. The difference was statistically significant(P<0.05) at 12 h after operation and 48 h after operation, and did not fall to the preoperative level at 72 h after surgery(compared with preoperation P<0.05). The levels of blood NGAL and urinary KIM-1 in the ESWL group began to increase at 2 h after surgery, and reached a peak at 6 h after surgery. Compared with 2 h after operation and 12 h after surgery, there existed significant difference(P<0.05). Then the concentration began to decrease and decreased to the preoperative level(P>0.05) at 72 h after surgery. The concentration of blood Cys-C increased at 2 h after operation, and the peak appeared at 48 h after operation. Compared with 24 h after operation and 72 h after operation, there existed significant difference(P<0.05). The concentration at 72 h after operation was significantly different from that before operation(P<0.05).Conclusion: Both URS and ESWL have impaired early renal function in senile patients, mainly in the damage of renal tubules and glomeruli, but the damage is reversible. In both surgical procedures, the damage and recovery time of the renal tubules were earlier than those of the glomeruli. For the treatment of stones below 2 cm, the effects of the two surgical methods on renal function in elderly patients were similar, but ESWL treatment was superior to URS in the damage and recovery time of renal tubules in elderly patients.
- ureteroscopic lithotripsy /
- extracorporeal shock wave lithotripsy /
- renal calculi /
- early renal function /
- elderly patients

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