经皮肾镜对复杂性肾结石患者术后早期肾功能的影响

目的探讨经皮肾镜碎石取石术(PCNL)对复杂性肾结石患者术后早期肾功能的影响,并评估患者术后肾功能恶化的危险因素。方法将77例自2017年1月至2018年8月在我院行PCNL的复杂性肾结石患者,根据术前基线肾功能分为肾功能正常(血肌酐<115μmol·L^-1)的A组和肾功能异常(血肌酐≥115μmol·L^-1)的B组,每组又根据手术通道数目,分为单通道组(通道数目=1)和多通道组(通道数目≥2),记录患者术前及术后24 h内的血肌酐及其他评价肾功能的指标,以此对患者术后肾功能进行评估。同时记录并评估可能对肾功能改变产生影响的相关因素。结果 A组中,仅在多通道患者中术后胱抑素C水平较术前升高,且差异有统计学意义(P<0.05)。其他指标几乎保持稳定状态(P>0.05)。B组中,单通道患者与A组相似,各指标基本保持稳定(P>0.05)。多通道患者术后血肌酐及胱抑素C水平显著上升,估算肾小球滤过率显著下降,差异有统计学意义(P<0.05)。导致肾功能恶化的独立危险因素包括术前高浓度血肌酐、多通道、糖尿病和高血压。结论多通道PCNL对肾功能不全患者的肾功能早期影响较大,多通道、术前肾损伤、糖尿病及高血压是肾功能减退的潜在危险因素。

Analysis of the effect of percutaneous nephrolithotomy on early renal function in patients with complicated renal calculi

ObjectiveTo investigate the effect of percutaneous nephrolithotomy on early renal function in patients with complicated renal calculi and to evaluate the risk factors for postoperative renal function deterioration. MethodsSeventy-seven patients with complicated renal calculi who underwent percutaneous nephrolithotomy in our hospital from January 2017 to August 2018 were divided into Group A (patients with normal renal function, serum creatinine <115 μmol·L^-1) and Group B (Patients with abnormal renal function, serum creatinine ≥115 μmol·L^-1) according to preoperative baseline renal function. Each group was divided into single access tract group (number of access tracts=1) and multiple access tracts group (number of access tracts≥2) according to the number of access tracts. Serum creatinine and other indicators of renal function before and 24 hours after surgery were recorded. At the same time, some factors that may affect the changes of renal function were recorded and evaluated. ResultsIn group A, multi-channel patients' postoperative cystatin C levels were higher than those before surgery. The difference was statistically significant (P<0.05). Other indicators remained almost steady (P>0.05). In group B, each index in single access tract patients remained basically stable (P>0.05). The levels of serum creatinine and cystatin C increased significantly after multiple access tracts patients, and the estimated glomerular filtration rate decreased significantly (P<0.05). Independent risk factors leading to deterioration of renal function included preoperative high concentrations of serum creatinine, multiple access tracts, diabetes, and hypertension. ConclusionMultiple access tracts PCNL has a significant effect on early renal function in patients with renal insufficiency. Preoperative renal injury, diabetes and hypertension are potential risk factors for renal dysfunction.