软输尿管镜钬激光碎石术治疗孤立肾肾结石手术时间与术后肾功能恶化的相关性研究：单中心42例回顾性研究

Correlation between operation time and renal function deterioration of flexible ureteroscope in treating renal stones in a solitary kidney：42 cases of single center retrospective study

摘要:

目的：探讨软输尿管镜钬激光碎石术治疗孤立肾肾结石手术时间与术后肾功能恶化的相关性。方法：回顾性分析我院2013年1月至2016年12月间利用软输尿管镜治疗的孤立肾结石患者，随访1年，将术后1年内血肌酐无明显升高（P＞0.05）的患者作为实验组，术后1年内血肌酐明显升高（P＜0.05）的患者作为对照组。记录2组患者的手术时间、术后1个月、术后1年血肌酐的变化，比较2组患者年龄、性别、BMI、结石大小、手术次数、清石率、肾积水、高血压、糖尿病等指标。结果：最终能完整随访1年并纳入回顾性研究的共42例患者。其中实验组33例，对照组9例。实验组和对照组患者年龄、性别、BMI、手术次数、清石率、肾积水、高血压、糖尿病等差异无统计学意义（P＞0.05），但对照组结石大小、手术时间以及术后感染相关并发症明显高于实验组（P＜0.05）。2组患者术前血肌酐差异无统计学意义（P＞0.05），但术后1个月及1年复查血肌酐，对照组均明显升高（P＜0.05）。ROC曲线统计分析结果显示，预测肾功能不可逆受损的手术时间为56 min，曲线下面积为0.78，敏感性和特异性分别为81.8%和66.7%。结论：软输尿管镜钬激光碎石术治疗孤立肾肾结石安全性较高，但手术时间应控制在56 min内，否则可能造成肾功能持续的不可逆受损，最终导致肾功能恶化。

Abstract:

Objective：To explore the correlation between operation time and renal function deterioration of flexible ureteroscope in treating renal stones in a solitary kidney postoperatively. Methods：From January 2013 to December 2016，patients with renal stones in a solitary kidney were treated with fURS and followed up for one year in our hospital. Patients whose serum creatinine had elevated obviously were taken as control group and the other patients were as study group. Operation time and serum creatinine one month and one year after operation were recorded. Other parameter including age，gender，body mass index，stone size，number of procedures，stone free rate，hydronephrosis，hypertension and diabetes were analyzed. Results：A total of 42 patients were included in the retrospec－tive study：33 patients were in the study group and 9 patients were in the control group. There was no statisticallydifference in factors such as age，gender，body mass index，number of procedures，stone free rate，hydronephrosis，hypertension and diabetes had（P>0.05）. Other factors such as stone size，operation time and postoperative infection-related complication were higher in the control groupthan in the study group（P<0.05）. Preoperative serum creatininehad no statisticallydifference between the two groups（P>0.05）. But postop－erative serum creatinine in the control group one month and one year after operation were higher than that in the study group（P<0.05）. The area under the receiver operating characteristic curve of operation time in predicting the deterioration of renal function was 0.78 and the cutoff point was 56minutes（95%CI=0.617 to 0.950），in which the sensitivity and specificity were respectively 81.8% and 66.7%. Conclusion：Flexible ureteroscope was a safe treatment method for renal stones in solitary kidney at one year follow-up. But operation time should be controlled within 56minutes. Otherwise，kidney function will be damaged irreversibly and eventually lead to the deterioration of renal function.