Ⅰ期经皮肾镜取石术术后结石残留的相关因素分析
|
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.
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
[1]Bai Y,Tang Y,Deng L,et al.Management of large renal stones:laparoscopic pyelolithotomy versus percutaneous nephrolithotomy[J].BMC Urol,2017,17(1):75.
[2]蓝志相,蔡斌,梁建波,等.Ⅰ期经皮肾镜取石术术后结石残留的影响因素分析[J].广西医学,2015,37(8):1110-1113.
[3]Palmero X,Balssa L,Bernardini S,et al.Flexible ureterorenoscopy vs percutaneous nephrolithotomy for renal stone managemen:Retrospective study[J].Prog Urol,2016,26(9):500-506.
[4]袁琼芳.加速康复外科理念在骨科患者围手术期护理的效果观察[J].医学信息,2015,28(51):150.
[5]那彦群,叶章群,孙光,等.中国泌尿外科疾病诊断治疗指南(2011版)[M].北京:人民卫生出版社,2011.
[6]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:129-242.
[7]彭作锋,朱伦锋,钟愉明,等.微创经皮肾镜碎石术联合输尿管软镜碎石术治疗孤立肾结石的临床研究[J].当代医学,2018,24(1):13-15.
[8]高小峰,李凌.输尿管软镜在肾结石治疗中的应用[J].现代泌尿外科杂志,2011,16(5):387-390.
[9]陈佩霞,林晓华,徐英华,等.微信平台健康宣教在肾结石微创手术患者延续护理中的应用效果[J].中国当代医药,2017,24(17):191-193.
[10]邱爱芬.网络微信访视对泌尿系统结石患者术后健康知识掌握及复发率的影响[J].青岛医药卫生,2016,48(2):152-154.
[11]何金华,霍山,饶惠平,等.广东省中山市外来务工人员泌尿系统结石发病相关危险因素分析[J].中国基层医药,2013,20(15):2266-2268.
[12]杨祥海.微肾镜取石术联合大功率钬激光治疗老年复杂肾结石的疗效及安全性探讨[J].实用中西医结合临床,2016,16(2):43-44.
[13]陈雷振,许海峰,闫兵,等.经皮肾镜取石术肾穿刺辅助套件的临床应用[J].天津医药,2013,41(8):832-833.
[14]张博威,庞晋萍,宋丽.微创经皮肾镜取石术并发症的原因及防治策略[J].实用医技杂志,2011,18(12):1317-1318.
[15]Lojanapiwat B,Tanthanuch M,Pripathanont C,et al.Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy[J].Int Braz J Urol,2011,37(5):611-616.
[16]金奎龙,崔尚允,池亨根.肾盂肾盏的形态观察[J].延边医学院学报,1982(2):27-32.
[17]褚健,曹建伟,邓晓俊,等.Ⅰ期多通道微创经皮肾镜碎石取石术治疗树枝型肾结石[J].国际泌尿系统杂志,2014,34(3):316-319.
[18]樊长晖,许长宝,赵兴华,等.输尿管软镜治疗并发肾功能不全肾结石患者的有效性及安全性分析[J].临床外科杂志,2017,25(2):116-119.
[19]张乃文,张祥字,刘炀,等.经皮肾镜碎石术术中及术后出血的影响因素分析[J].中国医科大学学报,2012,41(3):275-277.
[20]陈欲茂.膀胱软镜联合PCNL治疗肾结石患者的临床效果[J].国际泌尿系统杂,2016,36(6):828-831.
[2]蓝志相,蔡斌,梁建波,等.Ⅰ期经皮肾镜取石术术后结石残留的影响因素分析[J].广西医学,2015,37(8):1110-1113.
[3]Palmero X,Balssa L,Bernardini S,et al.Flexible ureterorenoscopy vs percutaneous nephrolithotomy for renal stone managemen:Retrospective study[J].Prog Urol,2016,26(9):500-506.
[4]袁琼芳.加速康复外科理念在骨科患者围手术期护理的效果观察[J].医学信息,2015,28(51):150.
[5]那彦群,叶章群,孙光,等.中国泌尿外科疾病诊断治疗指南(2011版)[M].北京:人民卫生出版社,2011.
[6]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:129-242.
[7]彭作锋,朱伦锋,钟愉明,等.微创经皮肾镜碎石术联合输尿管软镜碎石术治疗孤立肾结石的临床研究[J].当代医学,2018,24(1):13-15.
[8]高小峰,李凌.输尿管软镜在肾结石治疗中的应用[J].现代泌尿外科杂志,2011,16(5):387-390.
[9]陈佩霞,林晓华,徐英华,等.微信平台健康宣教在肾结石微创手术患者延续护理中的应用效果[J].中国当代医药,2017,24(17):191-193.
[10]邱爱芬.网络微信访视对泌尿系统结石患者术后健康知识掌握及复发率的影响[J].青岛医药卫生,2016,48(2):152-154.
[11]何金华,霍山,饶惠平,等.广东省中山市外来务工人员泌尿系统结石发病相关危险因素分析[J].中国基层医药,2013,20(15):2266-2268.
[12]杨祥海.微肾镜取石术联合大功率钬激光治疗老年复杂肾结石的疗效及安全性探讨[J].实用中西医结合临床,2016,16(2):43-44.
[13]陈雷振,许海峰,闫兵,等.经皮肾镜取石术肾穿刺辅助套件的临床应用[J].天津医药,2013,41(8):832-833.
[14]张博威,庞晋萍,宋丽.微创经皮肾镜取石术并发症的原因及防治策略[J].实用医技杂志,2011,18(12):1317-1318.
[15]Lojanapiwat B,Tanthanuch M,Pripathanont C,et al.Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy[J].Int Braz J Urol,2011,37(5):611-616.
[16]金奎龙,崔尚允,池亨根.肾盂肾盏的形态观察[J].延边医学院学报,1982(2):27-32.
[17]褚健,曹建伟,邓晓俊,等.Ⅰ期多通道微创经皮肾镜碎石取石术治疗树枝型肾结石[J].国际泌尿系统杂志,2014,34(3):316-319.
[18]樊长晖,许长宝,赵兴华,等.输尿管软镜治疗并发肾功能不全肾结石患者的有效性及安全性分析[J].临床外科杂志,2017,25(2):116-119.
[19]张乃文,张祥字,刘炀,等.经皮肾镜碎石术术中及术后出血的影响因素分析[J].中国医科大学学报,2012,41(3):275-277.
[20]陈欲茂.膀胱软镜联合PCNL治疗肾结石患者的临床效果[J].国际泌尿系统杂,2016,36(6):828-831.