无功能肾术前肾盂穿刺液成分对手术困难程度的前瞻性研究

A Prospective Study on the Correlation between Preoperative Pyelocentesis Fluid Components of Non-Functional Kidney and Surgical Difficulty

摘要: 目的：1) 探究肾穿刺肾盂内尿液成分与无功能肾切除手术方式相关性；2) 寻找某种肾盂内尿液准确成分可以准确决定无功能肾切除方式。方法：选取2022年10月至2025年1月在西藏自治区人民医院泌尿外科住院的无功能肾并行肾脏切除患者30例，将其病因进行分析，并对患者进行严格的术前评估，术前穿刺取样并送检，记录患者术中情况及术后并发症情况，其术后并发症按Clavien-Dindo分级系统对并发症严重程度进行分级，Clavien ≥ 2为显著并发症。同时根据手术方式，将其分为两组，研究组为腹腔镜手术组，对照组为机器人手术组，两者进行分析，再根据肾盂穿刺液成分，分析穿刺液与手术难度的相关性，从而进行术前预测系统，建立评分准则。结果：本研究组共纳入研究对象30例，根据手术方式分为研究组和对照组，将其一般情况、病因、肾盂穿刺液进行分析，具体结果如下：1) 将患者术前一般资料进行比较，发现年龄、高血压史、开放肾手术史比较差异均无统计学意义(P > 0.05)，而性别、糖尿病史差异在统计学上有意义(P < 0.05)；2) 将无功能肾病因进行分析发现，主要病因为肾结核、结石、肾盂输尿管连接处狭窄。3) 将手术时长、出血量、术后出院时间、总引流量、术后并发症、引流时间、进食时间分别与穿刺液成分进行相关性分析，手术时长、出血量与积水情况、乳酸脱氢酶、肌酐有关；总引流量与肌酐相关；进食时间与乳酸脱氢酶、腺苷脱氢酶、PLT、葡萄糖、白细胞、中性粒细胞比率相关。结论：本研究30例无功能肾患者，通过回顾性分析患者一般资料及病因，发现本研究中，肾结核为首要病因，占比53.33%；同时患者性别、既往有高血糖病史均在统计学上有意义，既往有高血糖病史的患者，肾周脂肪粘连比较严重，对于此类患者，术前要严格检测血糖，因其粘连严重，腹腔镜手术耗时长，手术方式一般选择机器人手术。本研究中，对比肾盂穿刺液成分与手术时长，发现积水程度、肌酐与手术时长高度相关，LDH呈中度相关；与术中出血量比较，积水程度高度相关，LDH与Cr中度相关；总引流量与Cr葡萄糖中度相关；进食时间与LDH、NEUT%、ADA、PLT、氯化物、白细胞均呈中度相关，其中与NEUT%的相关性更高；术后并发症与穿刺液的成分相关性为低度相关或弱相关。

Abstract: Objective: 1) To investigate the correlation between the composition of urine in the renal pelvis after renal puncture and the surgical approach of non-functional nephrectomy; 2) Finding the exact composition of urine in the renal pelvis can accurately determine the method of non-functional nephrectomy. Methods: A total of 30 patients with non-functioning kidneys who underwent nephrectomy at the Department of Urology, Xizang Autonomous Region People’s Hospital from October 2022 to January 2025 were enrolled in this study. The etiologies were analyzed, and rigorous preoperative evaluations were conducted. Preoperative renal puncture was performed to collect pyeloureteral urine for laboratory testing. Intraoperative conditions and postoperative complications were recorded, with the severity of complications graded according to the Clavien-Dindo classification system (Clavien ≥ 2 indicated significant complications). Based on the surgical approach, patients were divided into two groups: the laparoscopic surgery group (study group) and the robotic surgery group (control group), which were subsequently compared. Furthermore, the correlation between pyeloureteral puncture fluid composition and surgical difficulty was analyzed to establish a preoperative predictive system and develop a scoring criterion. Result: A total of 30 subjects were included in this study group, which were divided into a study group and a control group according to the surgical method. Their general condition, etiology, and renal pelvis puncture fluid were analyzed. The specific results are as follows: 1) By comparing the general data of patients before surgery, it was found that there was no statistically significant difference in age, hypertension history and open kidney surgery history (P > 0.05), but there was statistically significant difference in gender and diabetes history (P < 0.05); 2) Analysis of the causes of non-functional kidney disease revealed that the main causes were stones, hydronephrosis, tuberculosis, and stenosis at the renal pelvis ureteral junction; 3) Correlation analyses were performed between operative duration, intraoperative blood loss, postoperative hospital stay, postoperative complications, total drainage volume, drainage duration, time to oral intake, and the components of puncture fluid. Operative duration and intraoperative blood loss were found to be correlated with the degree of hydrops, lactate dehydrogenase (LDH), and creatinine (Cr). Total drainage volume showed correlation with creatinine. Time to oral intake was associated with lactate dehydrogenase, adenosine deaminase (ADA), platelet count (PLT), glucose, white blood cell count, and neutrophil percentage (NEUT%). Conclusion: This study analyzed 30 patients with nonfunctional kidneys. Retrospective analysis of patient demographics and etiologies revealed renal tuberculosis as the primary cause, accounting for 53.33% of cases. Furthermore, a statistically significant correlation was observed between patient gender, a history of hyperglycemia, and surgical difficulty. Patients with a history of hyperglycemia exhibited more severe perirenal adhesions, necessitating strict preoperative blood glucose monitoring. Due to the severity of adhesions, laparoscopic surgery in these cases was time-consuming, and robotic-assisted surgery was generally preferred. In this study, the composition of renal pelvis puncture fluid was compared with surgical duration, revealing a strong correlation between the degree of hydronephrosis, creatinine (Cr) levels, and operative time, while lactate dehydrogenase (LDH) showed a moderate correlation. Regarding intraoperative blood loss, the degree of hydronephrosis was strongly correlated, whereas LDH and Cr exhibited moderate correlations. Additionally, Cr and glucose levels demonstrated a moderate correlation with total drainage volume. LDH, neutrophil percentage (NEUT%), adenosine deaminase (ADA), platelet count (PLT), chloride levels, and white blood cell count were moderately correlated with the time to oral intake, with NEUT% showing a stronger association. Postoperative complications exhibited only a weak correlation with the composition of the puncture fluid.