微创经皮肾镜碎石取石术治疗感染性肾结石疗效及对血清hs—CRP水平、结石清除率和肾功能的影响(1)
【摘要】 目的：比较微创经皮肾镜取石术(MPCNL)与标准通道经皮肾镜取石术(PCNL)治疗感染性肾结石的效果及对血清超敏C反应蛋白(hs-CRP)水平、结石清除率和肾功能的影响。方法：选取2012年
10月-2017年7月本院诊治的感染性肾结石患者80例，按照随机数字表法分为观察组和对照组，各40例。观察组采用MPCNL治疗，对照组采用PCNL治疗，比较两组手术时间、术中出血量、手术前后的肌酐和hs-CRP水平、结石清除率及并发症情况。结果：术后，两组肌酐、hs-CRP水平均高于术前(P<0.05)，但观察组肌酐、hs-CRP水平均低于对照组(P<0.05)；观察组手术时间长于对照组(P<0.05)；观察组出血量少于对照组，但比较差异无统计学意义(P>0.05)；观察组一次性结石清除率为65.00%(26/40)，低于对照组的85.00%(34/40)，比较差异有统计学意义(P<0.05)。结论：对于感染性肾结石患者而言，PCNL一次性结石清除率更高，但MPCNL对肾功能损伤更小，且术后炎症反应较轻，值得推广。
【关键词】 感染性肾结石； 微创经皮肾镜取石术； 炎症反应； 肾功能
【Abstract】 Objective：To compare the efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL) and standard channel percutaneous nephrolithotomy(PCNL) for the treatment of infectious kidney stones and its effects on serum high sensitivity C reactive protein(hs-CRP) level，stone clearance rate and renal function.Method：A total of 80 patients with infectious kidney stones who were treated in our hospital from October 2012 to July 2017 were selected，according to the random number table method，they were divided into observation group and control group，40 cases in each group.The observation group was treated with MPCNL，and control group was treated with PCNL.The operation time，intraoperative amount of bleeding，the levels of creatinine and hs-CRP before and after operation，stone clearance rate and complications of two groups were compared.Result：After operation，the levels of creatinine and hs-CRP in two groups were higher than those of before operation(P<0.05)，but the creatinine and the levels of hs-CRP in observation group were lower than those of control group(P<0.05).The operation time of observation group was longer than that of control group(P<0.05)，the intraoperative amount of bleeding in observation group was less than that of control group，but the difference was not statistically significant(P>0.05).The disposable stone clearance rate in observation group was 65.00%(26/40)，which was lower than 85.00%(34/40) of the control group，and the difference was statistically significant(P<0.05).Conclusion：For patients with infectious kidney stones，the PCNL disposable stone clearance rate is higher，but MPCNL has less damage to the renal function，and the postoperative inflammatory reaction is mild，it is worth promoting.
【Key words】 Infectious kidney stones； MPCNL； Inflammatory reaction； Renal function
First-author’s address：The Second Hospital of Xinyu，Xinyu 338000，China
doi：10.3969/j.issn.1674-4985.2017.36.002
肾结石是常见的泌尿系统疾病，可发生于肾盂、肾盏或肾盂与输尿管连接处，以尿痛、血尿、排尿中断为主要表现，严重者可对肾脏造成损伤。感染性结石是其中的特殊类型，患者可表现为尿液pH>7.0，尿检可存在大量脓细胞，并可见“棺材盖”样磷酸铵镁结晶，尿培养可见解脲酶细菌等[1-2]。感染性肾结石的治疗可分为内科保守及外科手术治疗，但单纯药物干预往往难以控制感染，且对于直径较大的结石并不能有效清除，甚至可因结石易位引起尿路梗阻[3]。目前经皮肾镜取石术已成为直径>2 cm的结石的首选方案，一般认为标准通道经皮肾镜取石术(PCNL)较微创经皮肾镜术(MPCNL)而言创伤较大，但有研究表明其在結石清除率方面并无优势，且各项研究结果差异较大[2-3]。本研究选取感染性肾结石患者80例，对两种手术方案的疗效进行观察，现报道如下。, 百拇医药(谢炜)
10月-2017年7月本院诊治的感染性肾结石患者80例，按照随机数字表法分为观察组和对照组，各40例。观察组采用MPCNL治疗，对照组采用PCNL治疗，比较两组手术时间、术中出血量、手术前后的肌酐和hs-CRP水平、结石清除率及并发症情况。结果：术后，两组肌酐、hs-CRP水平均高于术前(P<0.05)，但观察组肌酐、hs-CRP水平均低于对照组(P<0.05)；观察组手术时间长于对照组(P<0.05)；观察组出血量少于对照组，但比较差异无统计学意义(P>0.05)；观察组一次性结石清除率为65.00%(26/40)，低于对照组的85.00%(34/40)，比较差异有统计学意义(P<0.05)。结论：对于感染性肾结石患者而言，PCNL一次性结石清除率更高，但MPCNL对肾功能损伤更小，且术后炎症反应较轻，值得推广。
【关键词】 感染性肾结石； 微创经皮肾镜取石术； 炎症反应； 肾功能
【Abstract】 Objective：To compare the efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL) and standard channel percutaneous nephrolithotomy(PCNL) for the treatment of infectious kidney stones and its effects on serum high sensitivity C reactive protein(hs-CRP) level，stone clearance rate and renal function.Method：A total of 80 patients with infectious kidney stones who were treated in our hospital from October 2012 to July 2017 were selected，according to the random number table method，they were divided into observation group and control group，40 cases in each group.The observation group was treated with MPCNL，and control group was treated with PCNL.The operation time，intraoperative amount of bleeding，the levels of creatinine and hs-CRP before and after operation，stone clearance rate and complications of two groups were compared.Result：After operation，the levels of creatinine and hs-CRP in two groups were higher than those of before operation(P<0.05)，but the creatinine and the levels of hs-CRP in observation group were lower than those of control group(P<0.05).The operation time of observation group was longer than that of control group(P<0.05)，the intraoperative amount of bleeding in observation group was less than that of control group，but the difference was not statistically significant(P>0.05).The disposable stone clearance rate in observation group was 65.00%(26/40)，which was lower than 85.00%(34/40) of the control group，and the difference was statistically significant(P<0.05).Conclusion：For patients with infectious kidney stones，the PCNL disposable stone clearance rate is higher，but MPCNL has less damage to the renal function，and the postoperative inflammatory reaction is mild，it is worth promoting.
【Key words】 Infectious kidney stones； MPCNL； Inflammatory reaction； Renal function
First-author’s address：The Second Hospital of Xinyu，Xinyu 338000，China
doi：10.3969/j.issn.1674-4985.2017.36.002
肾结石是常见的泌尿系统疾病，可发生于肾盂、肾盏或肾盂与输尿管连接处，以尿痛、血尿、排尿中断为主要表现，严重者可对肾脏造成损伤。感染性结石是其中的特殊类型，患者可表现为尿液pH>7.0，尿检可存在大量脓细胞，并可见“棺材盖”样磷酸铵镁结晶，尿培养可见解脲酶细菌等[1-2]。感染性肾结石的治疗可分为内科保守及外科手术治疗，但单纯药物干预往往难以控制感染，且对于直径较大的结石并不能有效清除，甚至可因结石易位引起尿路梗阻[3]。目前经皮肾镜取石术已成为直径>2 cm的结石的首选方案，一般认为标准通道经皮肾镜取石术(PCNL)较微创经皮肾镜术(MPCNL)而言创伤较大，但有研究表明其在結石清除率方面并无优势，且各项研究结果差异较大[2-3]。本研究选取感染性肾结石患者80例，对两种手术方案的疗效进行观察，现报道如下。, 百拇医药(谢炜)