The influence of percutaneous nephrolithotomy on human systemic stress response, SIRS and renal function
The influence of percutaneous nephrolithotomy on human systemic stress response, SIRS and renal function
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经皮肾镜取石术对人体全身应激反应、SIRS及肾功能的影响
DOI：
10.1007/s00240-010-0259-4
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发表时间：
2010-10-01
影响因子：
--
通讯作者：
Huang, Jiaoti
中科院分区：
文献类型：
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作者：
Shen, Pengfei;Wei, Wuran;Huang, Jiaoti
本研究旨在探讨经皮肾镜取石术（PNL）与开放手术取石术对全身应激反应、全身炎症反应综合征（SIRS）及肾功能的影响。40例肾结石患者入组研究。20例患者随机分为PNL组和开放手术组。检测C反应蛋白（CRP）、白细胞介素6（IL-6）、β2-微球蛋白（β2-MG）水平、呼吸率、心率、体温和白色细胞计数。分别于术前和术后第1、3、6天测定CRP和IL-6。CRP和IL-6在术后第3天和第1天达到峰值，术后第1天下降，差异有统计学意义（P< 0.05）。两组CRP、IL-6水平比较差异有统计学意义（P< 0.05）。术后第1天，PNL组发生SIRS 5例，开放手术组发生SIRS 12例，两组比较差异有统计学意义（P< 0.05）。血清β2-MG与CRP同时测定，组内及组间比较无显著性差异（P> 0.05）。还测量了尿β2-MG水平。PNL前与术后第1天比较差异有统计学意义（P< 0.05），PNL前与术后第3、6天比较差异无统计学意义（P> 0.05）。术前与术后第1、3天比较差异有统计学意义（P< 0.05），术后第6天与术前比较差异无统计学意义（P> 0.05）。结论：PNL组和开放手术组均存在不同程度的全身应激反应激活。PNL的应激反应程度低于开放手术，从血清免疫学角度证明了PNL的优越性。两组均有SIRS发生，但PNL组SIRS程度较轻。两组对术后肾小球滤过功能均无明显影响，对术后早期肾小管重吸收均有影响，但PNL组恢复快于开放手术组。提示PNL对肾功能影响小，安全可行。
The objective of this study is to investigate the influences of percutaneous nephrolithotomy (PNL) and open surgery nephrolithotomy on the systemic stress response, SIRS and renal function. Forty patients with kidney calculi were enrolled in the study. Twenty cases were randomized to the PNL group and the other twenty cases to the open surgery group. Levels of C-reactive protein (CRP), interleukin-6(IL-6), β2-microglobulin (β2-MG), respiration rate, heart rate, body temperature and white blood cell counts were examined. CRP and IL-6 were measured in all patients pre-operatively and on post-operative days 1, 3 and 6, respectively. There was significant difference in their pre- and post-operation levels (P< 0.05), with the peak of CRP and IL-6 observed at post-operative days 3 and 1, respectively. There was significant difference in both CRP and IL-6 between the two groups (P< 0.05). At post-operative day 1, there were 5 cases of SIRS in PNL group and 12 cases in open surgery group; there was significant difference between the two groups (P< 0.05). Serum β2-MG levels were measured as the same time as CRP and no significant changes were observed within or between the groups (P> 0.05). Urine β2-MG levels were also measured. There was significant difference between pre- and the first day post-PNL (P< 0.05); there was no significant difference between pre- and the third and sixth day post-PNL (P> 0.05). There was significant difference between pre- and first and third day post-open surgery (P< 0.05); but there was no significant difference between pre- and the sixth day post-open surgery (P> 0.05). There was significant difference between two groups at the first, third and sixth days (P< 0.05).Conclusions:The systemic stress response is activated both in PNL group and open surgery group to some extent. The degree of stress response of PNL is lower than that of open surgery, proving the advantages of PNL with reference to serum immunology. There were cases in both the groups with SIRS, but the degree of SIRS in PNL group was lesser than the other group. Both the groups have no obvious effect on glomerular filtration function after operation and have effect on renal tubular reabsorption in the early stage after operation; but the recovery of the PNL group is faster than the open surgery group. It is thus shown that PNL is much safer and more feasible and has lesser effect on renal function.