摘要
目的:回顾性分析评估微创经皮肾镜取石术(mPCNL)对孤立肾肾功能的影响。方法:自2004年1月～2011年4月,我科共采用mPCNL手术处理解剖或功能性孤立肾合并的上尿路结石患者47例。我们采用中国人修正的肾病膳食改良(MDRD)公式,基于血清肌酐水平测算估算肾小球滤过率(eGFR)。以eGFR作为mPCNL手术前后肾功能的变化的评估指标,单因变量多因素方差分析明确其预测性因素。结果:除5例患者合并肾积脓或严重肾功能不全,需先行肾穿刺造瘘,其余患者均一期行mPCNL手术。所有手术均一次成功,无需中转改开放手术或二次PCNL;结石清除率80.9%。对手术前后eGFR统计分析显示,PCNL术后1d平均eG-FR出现一过性下降,与术前比较差异无统计学意义(P>0.05),但术后3d内迅速恢复甚至超过术前水平即基线(P<0.05),至术后1个月时趋于稳定。亚组分析显示,不同年龄、性别以及有或无尿路感染等亚组手术前后平均eGFR变化趋势与总的平均eGFR基本一致;无肾积水亚组术后1d平均eGFR均显著低于基线(P<0.05),术后3d和1个月的平均eGFR与基线比较差异无统计学意义(P>0.05),而肾积水亚组术后1d平均eGFR略高于基线(P>0.05),术后3d和1个月eGFR均显著优于基线(P<0.05)。单因变量分析显示,年龄、性别、有无感染因素等对术后1d与术前eGFR的变化均无显著影响(P>0.05)。术后随访时间4～92个月,除5例明显出血需输血或动脉栓塞治疗外,未发生其他严重并发症。结论:mPCNL处理孤立肾合并结石疗效确切、微创、安全。尽管可能导致肾功能一过性损害,但这种损害可迅速恢复,因此mPCNL仍是孤立肾合并的上尿路结石的首选方案之一。
Objective： We reviewed and assessed impact of minimally invasive percutaneous nephrolithotomy （mPCNL） on renal function of solitary kidney. Method：From January 2004 to April 2011, a total of 47 patients with anatomical or functional solitary kidney, underwent mPCNL for the management of complicated upper urinary tract stones in our department. The modified rrlodification of diet in renal disease （MDRD）equation for Chinese patients was used to calculate estimated filtration rate （eGFR）based on level of serum creatinine, which was regarded as a measurement to make an assessment of eGFR change in preoperative and postoperative renal function. Univariate regression analysis was performed to determine the predictive factors of eGFR improvement or impairment. Result： Five of 47 patients who had complicated pyonephrosis or serious renal insufficiency needed a nephrostomy prior to lithotriptic procedures. Other patients underwent primary PCNL. All these mPCNL procedures were successful for one time,either a transfer to open surgery or a secondary PCNL is not needed. Stone-free rate was 80.9%. The mean eGFR reduced transiently on the first day postoperatively, the difference was not statistically significant com- pared with baseline level （P〈0.05）;but within 3 days it recovered rapidly and even exceeding baseline （P〈： 0.05） ,and become stable at one month postoperatively. Subgroup analysis revealed that the mean eGFR change profiles of different age,gender and with/without infection subgroups were accordant with that of total mean eG- FR. However, for the subgroup of patients without hydronephrosis, the mean eGFR of the postoperative first day was significant lower than baseline （P〈0.05）,the mean eGFR of the postoperative third day and one month had no statistically significant difference with baseline （P〉0.05） ;meanwhile for the subgroup of patients with hydro- nephrosis,mean eGFR was a little higher on postoperative first day than baseline （P〈0.05）, and mean eGFR ofpost
出处
《临床泌尿外科杂志》
2012年第1期42-45,共4页
Journal of Clinical Urology
关键词
孤立肾
肾功能
尿石症
经皮肾镜取石术
solitary kidney
renal function
urolithiasis
percutaneous nephrolithotripsy
