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超微经皮肾镜碎石术对合并糖尿病的肾结石患者预后的影响

Effect of ultra-mini percutaneous nephrolithotomy on prognosis of renal calculus patients complicated with diabetes mellitus

    摘要
  • 摘要:
    目的 探讨超微经皮肾镜碎石术(UMP)对合并糖尿病的肾结石患者预后的影响。
    方法 回顾性分析107例合并糖尿病的肾结石患者的临床资料, 并根据手术方式分为经皮肾镜碎石术组(PCNL组)52例和UMP组55例。比较2组围术期指标、结石清除率、肾功能指标血尿素氮(BUN)、肌酐(Scr)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(CysC)、炎性因子C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、应激指标皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、并发症发生率及术后6个月的复发率。
    结果 UMP组手术时间、术后首次下床活动时间、住院时间、术中出血量短于、少于PCNL组, 差异有统计学意义(P < 0.05)。UMP组术后1周、术后1个月的结石清除率分别为72.73%、94.54%, 高于PCNL组的57.69%、80.77%, 差异有统计学意义(P < 0.05)。治疗后, 2组患者BUN、Scr、NGAL、CysC水平均降低, 差异有统计学意义(P < 0.05), 但2组组间差异无统计学意义(P>0.05)。治疗后, 2组患者CRP、IL-6、TNF-α水平均升高, 但UMP组患者CRP、IL-6、TNF-α水平低于PCNL组, 差异均有统计学意义(P < 0.05)。治疗后, 2组患者Cor、NE、ACTH水平均升高, 但UMP组患者Cor、NE、ACTH水平低于PCNL组, 差异均有统计学意义(P < 0.05)。UMP组并发症发生率为7.27%, 低于PCNL组的23.08%, 差异有统计学意义(P < 0.05)。术后6个月时, UMP组复发率为1.82%, 低于PCNL组的11.54%, 差异有统计学意义(χ2=4.131, P=0.042)。
    结论 对合并糖尿病的肾结石患者实施UMP治疗可提高结石清除率, 减轻术后应激反应和炎性反应, 降低结石复发率, 值得推广应用。

     

    Abstract:
    Objective To explore the effect of ultra-mini percutaneous nephrolithotomy (UMP) on the prognosis of renal calculus patients complicated with diabetes mellitus.
    Methods The clinical materials of 107 renal calculus patients complicated with diabetes mellitus were retrospectively analyzed, and they were divided into percutaneous nephrolithotomy group (PCNL group) with 52 cases and UMP group with 55 cases according to different surgical methods. The perioperative indicators, stone clearance rate, renal function indexesblood urea nitrogen (BUN), serum creatinine (Scr), neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC), inflammatory factorsC reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), stress indicatorscortisol (Cor), norepinephrine (NE) and adrenocorticotropic hormone(ACTH), the incidence of complications and recurrence rate at 6 months after operation were compared between two groups.
    Results Operation time, primary time to bed-off activity after operation, hospital stay and intraoperative blood loss in the UMP group were significantly shorter and lower than those in the PCNL group (P < 0.05). The stone clearance rates at one week and one month after surgery in the UMP group were 72.73% and 94.54% respectively, which were significantly higher than 57.69% and 80.77% in the PCNL group (P < 0.05). After treatment, the levels of BUN, Scr, NGAL and CysC in both groups decreased significantly (P < 0.05), but there were no significant differences in indicators mentioned above between the two groups (P>0.05). After treatment, the levels of CRP, IL-6 and TNF-α in both groups increased significantly, but the levels of CRP, IL-6 and TNF-α in the UMP group were significantly lower than those in the PCNL group (P < 0.05). After treatment, the levels of Cor, NE and ACTH in both groups increased significantly, but the levels of Cor, NE and ACTH in the UMP group were significantly lower than those in the PCNL group (P < 0.05). The incidence of complications in the UMP group was 7.27%, which was significantly lower than 23.08% in the PCNL group (P < 0.05). At 6 months after surgery, the recurrence rate in the UMP group was 1.82%, which was significantly lower than 11.54% in the PCNL group (χ2=4.131, P=0.042).
    Conclusion For renal calculus patients complicated with diabetes mellitus, implementation of UMP treatment can increase the stone clearance rate, alleviate the postoperative stress response and inflammatory reactions and reduce recurrence rate of stone, so it is worthy of popularization and promotion.

     

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