摘要
目的探讨Ⅰ期经皮肾镜取石术(PCNL)术后结石残留的主要影响因素。方法回顾性分析2013年4月~2017年10月在河北省定州市人民医院泌尿外科收治的475例Ⅰ期PCNL治疗单侧肾结石患者围术期资料。术后结石残留患者为结石残留组(A组),共103例;无结石残留和临床无意义残留结石患者为对照组(B组),共372例。对可能影响Ⅰ期PCNL术后结石残留的相关因素进行单因素分析,并将有统计学意义的影响因素采用多因素Logisitic回归分析。结果Ⅰ期PNCL术后结石残留发生率为21.68%。肾盂类型、结石负荷、鹿角形肾结石、肾功能不全、手术通道以及手术出血量是Ⅰ期PCNL术后结石残留的独立危险因素(P <0.05)。结论结石负荷>1000 mm~2、分支型肾盂、鹿角形肾结石、肾功能不全、单通道及出血量>200 mL均可增加Ⅰ期PCNL术后结石残留的风险。术前正确评估肾盂类型,积极改善患者肾功能,对鹿角形肾结石或结石负荷过大的复杂肾结石术前制订个体化治疗方案,术中积极减少出血量,可有效地降低Ⅰ期PCNL术后结石残留的风险。
Objective To investigate the main influencing factors of residual stones after stage Ⅰ percutaneous nephrolithotomy(PCNL). Methods The perioperative data of 475 patients with unilateral renal calculi treated with PCNL in the urology department of Dingzhou People′s Hospital of Hebei Province from April 2013 to October 2017 were retrospectively analyzed. Patients with residual stones after operation were classified into the group of residual stones(group A), a total of 103 cases; the data of patients with no residual stones and clinically significant residual stones were classified into the control group(group B), a total of 372 cases. Univariate analysis was performed on factors that may affect the residual stones after stage Ⅰ PCNL, and statistically significant factors were analyzed by multivariate Logisitic regression. Results The incidence of residual calculi after stage Ⅰ PNCL was 21.68%. The type of renal pelvis, stone load,staghorn calculi, renal insufficiency, operative pathway and bleeding volume were independent risk factors for residual calculi after stage Ⅰ PCNL(P < 0.05). Conclusion Stone load > 1000 mm2, branched pelvis, staghorn calculi, renal insufficiency, single channel, and bleeding volume > 200 mL can increase the risk of residual calculi after stage ⅠPCNL. Preoperative correct assessment of the type of renal pelvis, active improvement of renal function, individualized treatment for staghorn calculi or complex renal calculi with excessive stones load, and active reduction of intraoperative bleeding can effectively reduce the risk of residual stones after stage Ⅰ PCNL.
引文
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