切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 117 -120. doi: 10.3877/cma.j.issn.1674-3253.2021.02.007

所属专题: 文献

临床研究

因结石梗阻导致化脓性肾盂肾炎患者内镜清除结石后肾功能的转归及影响因素研究
曹锐铃1,(), 张宇1, 陈乐仲1, 何思挺1, 刘鹏华1, 张福友1   
  1. 1. 518102 广东,深圳市宝安区中心医院(深圳大学第五附属医院)泌尿外科
  • 收稿日期:2020-01-15 出版日期:2021-04-01
  • 通信作者: 曹锐铃

The prognosis and influencing factors of renal function in patients with pyelonephritis caused by stone obstruction after endoscopic lithotripsy

Ruiling Cao1,(), Yu Zhang1, Lezhong Chen1, Siting He1, Penghua Liu1, Fuyou Zhang1   

  1. 1. Department of Urology, the Central Hospital of Bao'an District, Shenzhen 518102, China
  • Received:2020-01-15 Published:2021-04-01
  • Corresponding author: Ruiling Cao
引用本文:

曹锐铃, 张宇, 陈乐仲, 何思挺, 刘鹏华, 张福友. 因结石梗阻导致化脓性肾盂肾炎患者内镜清除结石后肾功能的转归及影响因素研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(02): 117-120.

Ruiling Cao, Yu Zhang, Lezhong Chen, Siting He, Penghua Liu, Fuyou Zhang. The prognosis and influencing factors of renal function in patients with pyelonephritis caused by stone obstruction after endoscopic lithotripsy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(02): 117-120.

目的

探讨因结石梗阻导致化脓性肾盂肾炎患者内镜清除结石后肾功能的转归及影响因素。

方法

选择我院2014年3月至2017年10月间收治的124例结石梗阻导致化脓性肾盂肾炎患者,分析其临床资料,124例患者均接受内镜清石治疗,术后随访2年,评估患者内镜清除结石后肾功能的转归及影响因素。

结果

术前患肾GFR水平低于术后水平;而术前血肌酐水平高于术后水平,随访结果显示术后70例患者肾功能好转;54例患者出现肾功能损伤。分析资料发现,肾功能恢复组与肾功能损害组患者在性别、年龄、高尿酸血症、术前GFR、重度积水、糖尿病、肾周感染、术前C反应蛋白、术前PCT等因素资料结果中比较差异有统计学意义(P<0.05);而高热、结石负荷等资料结果比较差异无统计学意义(P>0.05)。多因素Logistic回归分析,发现年龄、术前GFR、重度积水、肾周感染等因素是结石梗阻性脓肾患者术后肾功能转归的独立影响因素。

结论

急性感染控制后,内镜清除梗阻性脓肾的结石后大部分患者肾功能可恢复,但老年患者、术前已经合并严重肾功能损害、重度积水、肾周感染等情况下结石梗阻性脓肾患者术后肾功能难以恢复。

Objective

To study the prognosis and influencing factors of renal function in patients with pyelonephritis due to stone obstruction after endoscopic lithotripsy.

Methods

The data of 124 cases of pyelonephritis caused by calculus obstruction in our hospital from March 2014 to February 2018 were analyzed. 124 cases were treated with endoscopic lithotripsy, the patients were followed up for 2 years to evaluate the prognosis of renal function and its influencing factors after endoscopic lithotripsy.

Results

Preoperative renal GFR level was lower than that after operation,while preoperative serum creatinine level was higher than that after operation. Follow-up results showed that renal function of 70 patientsimproved after operation. 54 patients presented with persistent renal impairment. While there were significant differences in age, hyperuricemia, preoperative GFR, severe hydronephrosis, diabetes mellitus, perirenal infection, C-reactive protein (CRP), procalcitonin(PCT) between the two groups (P<0.05). The results showed that there was no statistical difference in the data of high fever and stone load (P>0.05). Multivariate logistic regression analysis showed that age, preoperative GFR, severe hydronephrosis, perirenal infection and other factors were the independent influencing factors of postoperative renal function in patients with stone obstructive pyonephrosis.

Conclusion

After acute infection control, endoscopic removal of obstructive pyonephrosis stones is safe. Most patients' renal function can be restored after the removal of obstructive pyonephrosis. However, it is difficult to restore renal function in elderly patients, patients with severe renal impairment, severe hydronephrosis and perirenal infection.

表1 124例结石梗阻致脓肾患者术后肾功能转归情况
表2 124例结石梗阻致脓肾患者术后肾功能转归的单因素分析
表3 124例结石梗阻致脓肾患者术后肾功能转归的多因素分析
[1]
杨波,王起,王佳, 等. 结石梗阻性化脓性肾盂肾炎治疗后肾功能的转归及影响因素[J]. 中华泌尿外科杂志, 2018, 39(z1): 54-56.
[2]
周可义,赵春利,杨文增, 等. 可视标准通道联合可视超细通道经皮肾镜取石术精准穿刺治疗复杂性肾结石的临床应用[J].中国内镜杂志, 2017, 23(7): 109-112.
[3]
陈棉雄,黄达坤,许旭敏, 等. 经皮肾镜碎石术后发热的相关因素分析[J]. 中国内镜杂志, 2018, 24(4): 12-16.
[4]
汤春波,温海涛,齐勇, 等. 经皮肾镜取石术相关尿脓毒症预防及治疗[J]. 中国内镜杂志, 2014, 20(6): 662-665.
[5]
Kuntz JA, Berent AC, Weisse CW, et al. Double pigtail ureteral stenting and renal pelvic lavage for renal-sparing treatment of obstructive pyonephrosis in dogs: 13 cases (2008-2012)[J]. J Am Vet Med Assoc, 2015, 246(2): 216-225.
[6]
门晓炜,黄兴,王锐, 等. 经皮肾镜超声弹道碎石清石系统一期治疗结石梗阻性脓肾[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2009, 3(06): 516-518.
[7]
韩庆杰,吴万瑞,李远伟, 等. 腔镜技术治疗结石性脓肾54例临床分析[J]. 国际泌尿系统杂志, 2015, 35(2): 214-216.
[8]
赖德辉,盛明,李名钊, 等. 负压清石鞘在经皮肾镜治疗结石梗阻性脓肾中的应用[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(1):15-19.
[9]
韦正坤. 经皮肾镜钬激光碎石术分期治疗结石性脓肾的临床分析[J]. 国际泌尿系统杂志, 2015, 35(3): 378-381.
[10]
陈宏宇,韩毅,胡国栋, 等. 肾镜联合输尿管软镜通过经皮肾单通道取石治疗肾鹿角形结石[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(1): 28-31.
[11]
宫宝华. 观察泌尿外科腔镜技术治疗结石性脓肾的效果[J].中国卫生标准管理, 2018, 9(4): 42-44.
[12]
余小祥,赵东海,周大庆, 等. 选择性标准通道经皮肾镜Ⅰ期治疗结石性脓肾[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2014, 8(06): 37-40.
[13]
乔成建. 腔内泌尿外科技术治疗结石性脓肾患者的临床探究[J].中国实用医药, 2017, 12(29): 62-63.
[14]
李知阳. 腔内泌尿外科技术治疗结石性脓肾的疗效分析[J]. 深圳中西医结合杂志, 2016, 26(18): 118-119.
[15]
Francesco Simoni, Nicola Vitturi.Sepsis due to pyonephrosis: an adult with pelvic-ureteric junction obstruction (PUJO) in a duplex kidney[J]. J Ultrasound, 2015, 18(3): 301-304.
[1] 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[2] 杨建波, 马欢, 黄小梅, 刘华柱. 结肠镜辅助下EMR、CSP和RFA术治疗直径<1cm结直肠息肉的疗效和安全性比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 76-79.
[3] 王兴, 文阳辉, 姚戈冰, 郭平学, 杨自华. ICG荧光腹腔镜下胆囊切除术的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 663-666.
[4] 张超, 张珍, 马梁, 穆欢欢, 刘彩玲. 腹腔镜胰十二指肠切除术术后C级胰瘘患者临床特征及影响因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 675-678.
[5] 石兵, 张智, 陈金海, 唐文. 基于电磁跟踪和手术导航系统的实时超声引导下两种经皮肾盏穿刺方法的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 572-578.
[6] 吴春风, 卢国汉, 姚汝贺, 李健辉, 陈文杰, 黄宇. 21 F膀胱镜鞘联合8.0/9.8 F输尿管镜与等离子电切镜在膀胱结石钬激光碎石术中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 579-584.
[7] 石海波, 赵旭东, 王聪, 曲巍. 气肿性肾盂肾炎、气肿性膀胱炎并脓毒性休克一例报道并文献复习[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 644-647.
[8] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[9] 王秋生. 胆道良性疾病诊疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 779-782.
[10] 公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[11] 陈宗杰, 胡添松. 肝外伤破裂患者治疗后胆漏发生影响因素分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 836-840.
[12] 陈意志. 核磁共振钆造影剂导致的肾源性系统性纤维化[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 358-358.
[13] 吴广迎, 张延娟, 秦鹏, 卢艳丽. 经颈静脉肝内门体静脉分流术预防上消化道出血的临床研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 545-548.
[14] 倪颖, 张铁龙, 王岗, 高玉龙, 陈韶鹏, 倪家璇. 未预置支架逆行输尿管镜治疗近端输尿管结石手术中的困难与应对[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 795-801.
[15] 胡云鹤, 周玉焯, 付瑞瑛, 于凡, 李爱东. CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 568-574.
阅读次数
全文


摘要