影响肾结石行经皮肾镜术后清石率的多因素回归分析
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摘要
目的探讨影响肾结石行经皮肾镜碎石取石术(PCNL)后清石率的相关因素。方法回顾性分析2011年5月至2016年5月125例首次行PCNL治疗的肾结石患者的临床资料,利用术前超声、腹部平片(KUB)、静脉尿路造影(IVU)、CT平扫+三维重建影像资料,评估肾脏集合系统解剖情况、结石体表面积、肾积水程度、结石解剖分布、受累肾盏数、结石CT值。根据手术记录统计穿刺通道数、穿刺通道长度、穿刺通道大小、术中出血情况以及手术者经验情况。结石完全清除或残余碎片≤4 mm即为治疗成功。先对相关数据进行单因素分析,找出差异有统计学意义因素,再利用这些因素进行Logistic多因素回归分析。结果 92例患者结石一次性清除,清石率为73.6%。单因素分析表明,结石体表面积、结石解剖分布、肾脏集合系统解剖异常、受累肾盏数、穿刺通道长度、术中活动性出血、术者经验与清石率明显相关。多因素分析表明,结石体表面积、结石解剖分布、肾脏集合系统解剖异常、受累肾盏数是影响术后清石率的独立危险因素,术者经验是影响术后清石率的保护因素。结论肾脏集合系统解剖异常、结石大小及在肾盏的分布是影响肾结石行经皮肾镜取石术后效果的独立因素,可用于术前评估手术清石效果,术者的经验有益于提高清石率。
Objective To study the factors influencing the stone-free rate after percutaneous nephrolithotomy(PCNL) in kidney calculi. Methods Clinical data of 125 patients with nephrolithiasis underwent PCNL from May 2011 to May 2016 were retrospectively analyzed. Ultrasonic and KUB+IVU and computed tomography(CT) were used to evaluate the anatomy of the renal collecting system, area of calculus, degree of hydronephrosis, distribution of calculus, number of renal calculi and CT value of the calculi. Number of puncture channels, length of the puncture channel, size of the puncture channel, blood loss during operation and experience of the surgeon were recorded according to the operation records. Univariate analysis was performed for each factor. Factors found to be significantly different that were further analyzed using multivariate logistic regression analysis. Results The stones of 92 cases were cleared, clearance rate was 73.6%. Univariate analysis showed that the following factors were associated with the stone-free rate: area of calculus, distribution of calculus, abnormal anatomy of the renal collecting system, number of renal calculi, length of the puncture channel, blood loss during operation, experience of the surgeon. Multivariate analysis showed that the following risk factors were independently associated with the stone-free rate: area of calculus, distribution of calculus, abnormal anatomy of the renal collecting system, number of kidney calculi. Surgeon's experience was a protective factor associated with the stone-free rate. Conclusion Abnormal anatomy of the renal collecting system, size of the calculi and distribution in the calyx were independent factors of the effect of PCNL and can be used to evaluate the effect of surgery.Surgeon's experience was beneficial to increasing the stone-free rate.
Objective To study the factors influencing the stone-free rate after percutaneous nephrolithotomy(PCNL) in kidney calculi. Methods Clinical data of 125 patients with nephrolithiasis underwent PCNL from May 2011 to May 2016 were retrospectively analyzed. Ultrasonic and KUB+IVU and computed tomography(CT) were used to evaluate the anatomy of the renal collecting system, area of calculus, degree of hydronephrosis, distribution of calculus, number of renal calculi and CT value of the calculi. Number of puncture channels, length of the puncture channel, size of the puncture channel, blood loss during operation and experience of the surgeon were recorded according to the operation records. Univariate analysis was performed for each factor. Factors found to be significantly different that were further analyzed using multivariate logistic regression analysis. Results The stones of 92 cases were cleared, clearance rate was 73.6%. Univariate analysis showed that the following factors were associated with the stone-free rate: area of calculus, distribution of calculus, abnormal anatomy of the renal collecting system, number of renal calculi, length of the puncture channel, blood loss during operation, experience of the surgeon. Multivariate analysis showed that the following risk factors were independently associated with the stone-free rate: area of calculus, distribution of calculus, abnormal anatomy of the renal collecting system, number of kidney calculi. Surgeon's experience was a protective factor associated with the stone-free rate. Conclusion Abnormal anatomy of the renal collecting system, size of the calculi and distribution in the calyx were independent factors of the effect of PCNL and can be used to evaluate the effect of surgery.Surgeon's experience was beneficial to increasing the stone-free rate.
引文
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[14]邵志强,杨勇,杨渝,等.影响经皮肾镜取石术后结石清除率术前因素分析[J].微创泌尿外科杂志,2014,3(6):347-350.
[15]时浩清,骆磊,李斌,等.体质量指数对经皮肾镜碎石取石术疗效的影响[J/CD].中华腔镜泌尿外科杂志(电子版),2016,10(1):40-42.
[16]孙振,王彭,张建军.影响经皮肾镜碎石术治疗鹿角型肾结石清石率及并发症的因素分析[J/CD].泌尿外科杂志(电子版),2015,7(2):53-57.
[17]乔明洲,张海芳,周晨龙.肾结石患者经皮肾镜碎石术后结石残留影响因素分析[J].中华医学杂志,2015,95(44):3617-3619.
[18]陈富昌,李继清,刘刚,等.微通道与标准通道经皮肾镜取石术治疗肾结石的系统评价[J].中华腔镜泌尿外科杂志(电子版),2014,8(5):27-30.
[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]Rosa M,Usai P,Miano R,et a1.Recent finding and new technologies in nephrolitiasis:A review of the recent literature[J].BMC Urol,2013,13(1):10.
[4]卢启海,邱剑光,黄文涛,等.经皮肾镜碎石取石术治疗肾结石的现状[J/CD].中华腔镜泌尿外科杂志(电子版),2015,9(5):1-3.
[5]Elnahas AR,Eraky I,Shokeir AA,et a1.Factors affecting stonefree rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone[J].Urology,2012,79(6):1236-1241.
[6]Thomas K,Smith NC,Hegarty N,et a1.The Guy's stone scoregrading the complexity of percutaneous nephrolithotomy procedures[J].Urology,2011,78(2):277-281.
[7]胡卫国,李建兴,杨波,等.改良Guy'S肾结石分级法在预测经皮肾镜取石术后清石率中的应用研究[J].中华泌尿外科杂志,2012,33(10):771-773.
[8]Okhunov Z,Friedlander JI,George AK,et a1.S.T.O.N.E.nephrolithometry:novel surgical classification system for kidney calculi[J].Urology,2013,81(6):978-980.
[9]Akhavein A,Henriksen C,Syed J,et a1.Prediction of single procedure success rate using S.T.O.N.E.nephrolithometry surgical classification system with strict criteria for surgical outcome[J].Urology,2015,85(1):69-73.
[10]彭国辉,李汉忠,张玉石,等.SHA.LIN.评分系统的建立及其在预测经皮肾镜取石术结石清除率中的价值[J].中华泌尿外科杂志,2015,36(10):746-751.
[11]彭国辉,李汉忠,李秉诚,等.SHA.LIN、S.T.O.N.E评分系统和Guy'S分级法预测经皮肾镜取石术结石清除率准确性的比较研究[J].中华泌尿外科杂志,2016,37(3):199-205.
[12]钟东亮,郑少斌,单炽昌,等.经皮肾镜取石术后结石残留的原因分析[J].实用医学杂志,2014,30(17):2809-2811.
[13]段支前,严春晖.单通道经皮肾镜取石术术后结石残留因素分析及对策[J].临床外科杂志,2012,20(1):53-55.
[14]邵志强,杨勇,杨渝,等.影响经皮肾镜取石术后结石清除率术前因素分析[J].微创泌尿外科杂志,2014,3(6):347-350.
[15]时浩清,骆磊,李斌,等.体质量指数对经皮肾镜碎石取石术疗效的影响[J/CD].中华腔镜泌尿外科杂志(电子版),2016,10(1):40-42.
[16]孙振,王彭,张建军.影响经皮肾镜碎石术治疗鹿角型肾结石清石率及并发症的因素分析[J/CD].泌尿外科杂志(电子版),2015,7(2):53-57.
[17]乔明洲,张海芳,周晨龙.肾结石患者经皮肾镜碎石术后结石残留影响因素分析[J].中华医学杂志,2015,95(44):3617-3619.
[18]陈富昌,李继清,刘刚,等.微通道与标准通道经皮肾镜取石术治疗肾结石的系统评价[J].中华腔镜泌尿外科杂志(电子版),2014,8(5):27-30.