影响微创经皮肾取石术清石效果的相关因素分析
|
摘要
目的:分析影响微创经皮肾取石术(mPCNL)清石效果的相关因素。方法:2009年1月~2015年11月实施mPCNL共计258例,对其年龄、性别、体重指数、高血压、糖尿病、肾脏既往手术史、患肾侧别、结石长径、数目、表面积、所占肾盏数、肾积水程度、术者经验(术者完成mPCNL的例数)与结石清除率之间的关系进行分析,找出影响清石效果的主要因素。结果:本组Ⅰ期结石清除率为73.25%(189/258)。单因素分析显示结石长径、数目、表面积、所占肾盏数、肾积水程度、术者完成mPCNL例数六项因素与结石清除率之间的差异有统计学意义(P<0.05);而年龄、性别、体质指数、是否合并高血压、是否合并糖尿病、肾脏既往手术史、患肾侧别与结石清除率之间的差异均无统计学意义。Logistic回归分析显示:影响Ⅰ期mPCNL术后结石清除率的因素是结石长径、数目、表面积、所占肾盏数及肾积水程度。结论:结石越大、多发、所占肾盏数越多、肾积水程度越重,术后结石残留的可能性也越大。
Objective:To identify factors affecting the calculi clearance efficacy after minimally invasive percutaneous nephrolithotomy(mPCNL).Method:The data of 258 cases of mPCNL by a single surgeon from January2009 to November 2015 were reviewed retrospectively.Patients' age,sex,body mass index,diabetes status,hypertension status,previous open or PCNL history,surgeon's experience,degree of hydronephrosis,stone side,number,size,surface area and number of calyces involved were investigated.The correlation between above variables and stone-free status were analyzed respectively.A binary logistic regression analysis was performed to determine the statistically significant variables.Result:The stone-free rate after primary mPCNL was 73.25%(189/258).Univariate analysis revealed that the factors impacting the stone-free rate were stone number,size,surface area,number of calyces involved,degree of hydronephrosis and surgeon's experience.However,the stone-free rate couldn't be affected by patients' age,sex,body mass index,diabetes status,hypertension status,previous open or PCNL history.The binary logistic analysis showed that stone number,size,surface area,number of calyces involved and degree of hydronephrosis had significant influence on the stone-free rate after one-stage mPCNL.Conclusion:An increased stone number and size,surface area,number of calyces involved,moderate to severe hydronephrosis may be associated with decreased stone-free rates after mPCNL.
Objective:To identify factors affecting the calculi clearance efficacy after minimally invasive percutaneous nephrolithotomy(mPCNL).Method:The data of 258 cases of mPCNL by a single surgeon from January2009 to November 2015 were reviewed retrospectively.Patients' age,sex,body mass index,diabetes status,hypertension status,previous open or PCNL history,surgeon's experience,degree of hydronephrosis,stone side,number,size,surface area and number of calyces involved were investigated.The correlation between above variables and stone-free status were analyzed respectively.A binary logistic regression analysis was performed to determine the statistically significant variables.Result:The stone-free rate after primary mPCNL was 73.25%(189/258).Univariate analysis revealed that the factors impacting the stone-free rate were stone number,size,surface area,number of calyces involved,degree of hydronephrosis and surgeon's experience.However,the stone-free rate couldn't be affected by patients' age,sex,body mass index,diabetes status,hypertension status,previous open or PCNL history.The binary logistic analysis showed that stone number,size,surface area,number of calyces involved and degree of hydronephrosis had significant influence on the stone-free rate after one-stage mPCNL.Conclusion:An increased stone number and size,surface area,number of calyces involved,moderate to severe hydronephrosis may be associated with decreased stone-free rates after mPCNL.
引文
1 Osman MM,Alfano Y,Kamp S,et al.5-year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy[J].Eur Urol,2005,47(6):860-864.
2梁东彦,李巧星,邵军,等.微创经皮肾取石术并发肾出血的防治体会[J].实用医学杂志,2014:30(19):3158-3160.
3 Okhunov Z,Friedlander J I,George A K,et al.S.T.O.N.E nephmlithometry:novel surgical classification system for kidney calculi[J].Urology,2013,81(6):1154-1159.
4 Zhu Z,Wang S,Xi Q,et al.Logistic regression model for predicting stone-free rate after minimally invasive percutaneous nephrolithotomy[J].Urology,2011,78(1):32-36.
5 Mishra S,Sabnis R B,Desai M.Staghom morphometry:a new tool for clinical classification and prediction model for percutaneous nephrolithotomy monotherapy[J].J Endourol,2012,26(8):6-14.
6 Thomas K,Smith N C,Hegarty N,et al.The Guy's stone score:grading the complexity of pereutaneous nephrolithotomy procedures[J].Urology,2011,78(2):277-281.
7李炯明,刘建和,陈戬,等.微通道经皮肾镜取石术治疗上尿路结石的疗效及安全性评价(附4533例报告)[J].临床泌尿外科杂志,2011,26(3):174-176.
8 Tomaszewski J J,Smaldone M C,Schuster T,et al.Factors affecting blood loss during percutaneous nephrolithotomy using balloon dilation in a large contemporary series[J].J Endourol,2010,24(2):207-211.
9 EI-Nahas A R,Shokeir A A,EI-Assmy A M,et al.Post-percutaneous nephrolithotomy extensive hemorrhage:a study of risk factors[J].J Urol,2007,177(2):576-579.
10 Turna B,Nazli O,Demiryoguran S,et al.Percutaneous nephrolithotomy:variables that influence hemorrhage[J].Urology,2007,69(4):603-607.
11 Tanriverdi O,Boylu U,Kendirci M,et al.The learning curve in the training of percutaneous nephrolithotomy[J].Eur Urol,2007,52(1):206-212.
2梁东彦,李巧星,邵军,等.微创经皮肾取石术并发肾出血的防治体会[J].实用医学杂志,2014:30(19):3158-3160.
3 Okhunov Z,Friedlander J I,George A K,et al.S.T.O.N.E nephmlithometry:novel surgical classification system for kidney calculi[J].Urology,2013,81(6):1154-1159.
4 Zhu Z,Wang S,Xi Q,et al.Logistic regression model for predicting stone-free rate after minimally invasive percutaneous nephrolithotomy[J].Urology,2011,78(1):32-36.
5 Mishra S,Sabnis R B,Desai M.Staghom morphometry:a new tool for clinical classification and prediction model for percutaneous nephrolithotomy monotherapy[J].J Endourol,2012,26(8):6-14.
6 Thomas K,Smith N C,Hegarty N,et al.The Guy's stone score:grading the complexity of pereutaneous nephrolithotomy procedures[J].Urology,2011,78(2):277-281.
7李炯明,刘建和,陈戬,等.微通道经皮肾镜取石术治疗上尿路结石的疗效及安全性评价(附4533例报告)[J].临床泌尿外科杂志,2011,26(3):174-176.
8 Tomaszewski J J,Smaldone M C,Schuster T,et al.Factors affecting blood loss during percutaneous nephrolithotomy using balloon dilation in a large contemporary series[J].J Endourol,2010,24(2):207-211.
9 EI-Nahas A R,Shokeir A A,EI-Assmy A M,et al.Post-percutaneous nephrolithotomy extensive hemorrhage:a study of risk factors[J].J Urol,2007,177(2):576-579.
10 Turna B,Nazli O,Demiryoguran S,et al.Percutaneous nephrolithotomy:variables that influence hemorrhage[J].Urology,2007,69(4):603-607.
11 Tanriverdi O,Boylu U,Kendirci M,et al.The learning curve in the training of percutaneous nephrolithotomy[J].Eur Urol,2007,52(1):206-212.