输尿管软镜碎石取石术治疗直径 ≤ 2 cm的肾结石的疗效及对肾功能和炎症相关指标的影响

The therapeutic effect of retrograde intrarenal surgery on patients with renal calculus (diameter ≤ 2 cm) and its impact on renal function and inflammation

摘要:

目的 分析输尿管软镜碎石取石术（RIRS）治疗肾结石（直径 ≤ 2 cm）的疗效及对肾功能和炎症的影响。方法 选取2020年1月－2022年12月该院收治的肾结石（直径 ≤ 2 cm）患者194例，采用随机数表法分为超微经皮肾镜取石术（SMP）组（97例）和RIRS组（97例），分别给予SMP和RIRS治疗，两组患者术后均随访1周。比较两组患者手术情况、肾功能、应激反应、炎症相关指标和并发症发生情况。结果 RIRS组肾造瘘管留置时间和住院时间短于SMP组，术中出血量少于SMP组，差异均有统计学意义（P < 0.05）。两组患者术后1周血清半胱氨酸蛋白酶抑制剂C（Cys-C）、血肌酐（Scr）、尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）水平，以及术后24 h血清活性氧（ROS）、肾上腺素（AD）、去甲肾上腺素（NA）、促肾上腺皮质激素（ACTH）、脂质过氧化物（LPO）、白细胞介素-6（IL-6）、前列腺素E2（PGE2）和超敏C反应蛋白（hs-CRP）水平较术前升高，且RIRS组低于SMP组，差异均有统计学意义（P < 0.05）。RIRS组随访期间的并发症总发生率低于SMP组，差异有统计学意义（P < 0.05）。结论 与SMP相比，RIRS治疗肾结石（直径 ≤ 2 cm），具有创伤小、出血少、肾功能损害小、术后应激反应轻、炎症反应轻和安全性高等优势，可促进患者术后恢复。

Abstract:

Objective To investigate the therapeutic effect of retrograde intrarenal surgery (RIRS) on patients with renal calculus (diameter ≤ 2 cm) and its impact on renal function and inflammation.Methods From January 2020 to December 2022, 194 patients with renal calculus (diameter ≤ 2 cm) were divided into supermini percutaneous nephrolithotomy (SMP) group and RIRS group of 97 cases by random number talbe method. SMP group and RIRS group was treated with SMP and RIRS, all followed up for 1 week. Operation, renal function, stress response, inflammation-related indexes and complications were compared between the two groups.Results The time of indwelling of nephrostomy tube and hospital stay in RIRS groups were shorter than those in SMP groups, the intraoperative blood loss in RIRS groups was less than that in SMP group, the differences were statistically significant (P < 0.05). The levels of serum cystatin C (Cys-C), serum creatinine (Scr) and unine neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) 1 week after operation, and the serum reactive oxygen species (ROS), adrenaline (AD), noradrenaline (NA), adrenocorticotropic hormone (ACTH), lipid hydroperoxide (LPO), interleukin-6 (IL-6), prostaglandin E2 (PGE2) and hypersensitive C-reactive protein (hs-CRP) 24 h after operation in the two groups were higher than those before surgery, and the RIRS group were lower (P < 0.05). The overall complication rate during follow-up in the RIRS group was lower than that in SMP group (P < 0.05).Conclusion Compared with SMP, RIRS in the treatment of renal calculus (diameter ≤ 2 cm) has the advantages of less trauma, less bleeding, less renal damage, less postoperative stress, less inflammatory reaction and higher safety, which can promote postoperative recovery of patients.