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目的:前瞻性地通过对接受标准通道经皮肾镜取石术(SPCNL)与微创经皮肾镜取石术(MPCNL)患者的术前、术后手术侧肾盂尿液白介素-1(8IL-18)、白蛋白、β2微球蛋白的检测,综合性评估标准通道经皮肾镜取石术与微创经皮肾镜取石术对手术侧肾脏功能的影响。方法:采集2011年10月至2012年2月期间在娄底市三人民医院泌尿外科接受SPCNL的20例患者与MPCNL的20例患者的术前及术后的相关病史资料,其中男性30例,女性10例,平均年龄50.2±9.7岁。采用酶联免疫吸附法(ELISA)检测患者术前、术后6h、12h、48h、72h手术侧肾盂尿液IL-18水平,并检测手术侧肾盂尿白蛋白、β2微球蛋白,进行综合分析;同时化验患者术前、术后三天血肌酐,与尿IL-18、白蛋白、β2微球蛋白进行对比分析。结果:①SPCNL组及MPCNL组术后即时患者尿IL-18、白蛋白及β2微球蛋白水平均较术前有不同程度升高,(P<0.05)有统计学差异;②SPCNL组及MPCNL组术后6h、12h、48h、72h尿IL-18、白蛋白、β2微球蛋白均较术前显著升高,(P<0.05)有统计学意义;③SPCNL组及MPCNL组比较,在年龄、性别比例、平均结石大小、手术时间、术中术后并发症方面无差异(P>0.05),但术后即时以及术后6h、12h、48h、72h尿IL-18、白蛋白、β2微球蛋白数值比较有显著性差异(P<0.05);④尿IL-18、白蛋白、β2微球蛋白与血肌酐相比较,能更早的反应出手术对肾脏的损伤;⑤MPCNL组术中出现肾盂内高压的次数及维持时间明显多于PCNL组。结论:①SPCNL及MPCNL术后患者尿IL-18、白蛋白、β2微球蛋白均较术前显著升高,较血清肌酐更加敏感,更能早期的反映出手术对肾脏的损伤;②MPCNL与SPCNL相比,MPCNL较SPCNL对肾脏造成的损伤更大,其原因可能与肾盂高压有关,降低术中灌注压可减少手术侧肾脏功能的损害。
OBJECTIVE: To prospectively evaluate the efficacy and safety of preoperative and postoperative renal pelvic fluid interleukin-1 (8IL-18) in patients undergoing percutaneous nephrolithotomy (SPCNL) and minimally invasive percutaneous nephrolithotomy (MPCNL) ), Albumin and β2-microglobulin. We evaluated the effects of standard-channel percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy on the function of the kidney on the operated side. Methods: Twenty patients with 20 cases of SPCNL and 20 cases of MPCNL who underwent urology at Three People’s Hospital of Loudi between October 2011 and February 2012 were enrolled in the study. Preoperative and postoperative history data were collected, including 30 males 10 cases, the average age of 50.2 ± 9.7 years. The levels of IL-18 in preoperative and postoperative 6h, 12h, 48h, 72h after operation were determined by enzyme-linked immunosorbent assay (ELISA), and the urinary albumin and β2 microglobulin in operation were detected and analyzed comprehensively At the same time, the patients’ serum creatinine was compared with urine IL-18, albumin and β2 microglobulin before and three days after operation. Results: ①The urinary levels of IL-18, albumin and β2-microglobulin in patients with immediate postoperative urinary albumin (SPCNL) and MPCNL were significantly higher than those before operation (P <0.05); ②SPCNL and MPCNL Urine levels of IL-18, albumin and β2-microglobulin increased significantly at 6h, 12h, 48h and 72h after operation (P <0.05); ③Compared with pretreatment group, (P> 0.05). However, the urinary IL-18, albumin, β2-microglobulin values at postoperative immediately and 6h, 12h, 48h, 72h after operation were not significantly different (P <0.05) .④Compared with serum creatinine, urinary IL-18, albumin and β2 microglobulin could reflect the injury of the kidney earlier; The number and duration of maintenance significantly more than PCNL group. Conclusion: ①The urinary levels of IL-18, albumin and β2-microglobulin in patients withSPCNL and MPCNL are significantly higher than those before operation, more sensitive than serum creatinine, Compared with SPCNL, MPCNL caused more damage to the kidneys. The reason may be related to renal pelvic hypertension. Reducing the intraoperative perfusion pressure can reduce the damage of the renal function of the operation side.