摘要
目的比较不同程度肾积水对微创经皮肾镜取石术效率和结石清除率的影响.方法回顾性分析2017年10月至2019年9月在福建医科大学附属第一医院泌尿外科就诊的120例行微创经皮肾镜取石术(mini-mally invasive percutaneous nephrolithotomy,MPCNL)的肾结石患者的临床资料,根据肾积水严重程度分为无肾积水组(n=39)、轻度肾积水组(n=26)、中度肾积水组(n=34)和重度肾积水组(n=21).收集患者围术期相关指标,比较术前人口统计学特征及结石特征,分析手术时间、住院时间、结石清除率、穿刺部位、通道数、血红蛋白减少量、术后感染等并发症分级情况,分别使用单因素和多因素分析影响手术时间和结石清除率的危险因素.结果中、重度积水组患者血肌酐值较无肾积水组升高,差异有统计学意义(P=0.018).重度积水患者手术时间、住院天数明显延长(P=0.017、0.038),结石清除率降低(P=0.011),术后血红蛋白减少量明显增加(P=0.022).单因素分析显示,肾积水程度、体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)史、结石数量、结石分布、结石类型、结石体积及通道数均与手术时间相关;多元线性回归分析肾积水程度、结石数量、结石分布、结石类型、结石体积均是影响手术时间的独立危险因素.单因素分析显示,肾积水程度、结石数量、结石分布、结石类型、结石体积及通道数影响结石清除率;多元回归分析显示,重度肾积水、结石数量、结石分布是影响结石清除率的独立影响因素.结论轻、中度肾积水不影响MPCNL效率和结石清除率,但重度肾积水可以导致手术时间、住院时间延长,结石清除率显著降低,重度肾积水是影响MPCNL效率和结石清除率的独立危险因素.
Objective This study aimed to compare the effects of the degree of hydronephrosis on the stone clearance rate of minimally invasive percutaneous nephrolithotomy(MPCNL).Methods The clinical data for 120 patients with renal calculi who underwent MPCNL between October 2017 and September 2019 at the Department of Urology,First Affiliated Hospital of Fujian Medical University,were retrospectively analyzed.The patients were divided into no hydronephrosis group(n=39),mild hydronephrosis group(n=26),moderate hydronephrosis group(n=34)and severe hydronephrosis group(n=21).The related indexes in the perioperative period were collected,and the demographic characteristics and stone characteristics before the operation were compared.The operation time,hospitalization time,stone clearance rate,puncture site,number of channels,hemoglobin reduction,postoperative infection rate and other complications were analyzed.The risk factors associated with operation time and stone clearance rate were examined with univariate and multivariate analyses.Results No significant difference was observed in sex,age,body mass index(BMI),history of hypertension,diabetes,open kidney operation history,extracorporeal shock wave lithotripsy history,preoperative blood urea nitrogen,hemoglobin and urine culture results.The serum creatinine levels in patients with moderate and severe hydrops were higher than those in patients without hydronephrosis,and the difference was statistically significant(P=0.018).There was no significant differences in the side,number,distribution,type,density and volume of stones.The operation times in patients with severe hydronephrosis were significantly prolonged(P=0.017),the number of hospitalization days was prolonged(P=0.038),the stone clearance rate decreased(P=0.011),and the postoperative hemoglobin reduction significantly increased(P=0.022).There was no significant difference in the puncture site,channel number,postoperative infection and complication grade.Univariate analysis showed that the degree of hydronephrosis,hi
作者
毛厚平
施祝贤
江涛
高星健
陈文炜
张泽栋
张华
叶华
蔡卫平
吕夷松
Mao Houping;Shi Zhuxian;Jiang Tao;Gao Xingjian;Chen Wenwei;Zhang Zedong;Zhang Hua;Ye Hua;Cai Weiping;Lv Yisong(Department of Urology,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian,350005,China;Department of Urology,Women's and Children's Hospital Affiliated to Xiamen University,Xiamen,Fujian,361003,China;Department of Urology,General Hospital of Funeng Group,Fuzhou,Fujian,350005,China)
出处
《泌尿外科杂志（电子版）》
2021年第3期25-32,共8页
Journal of Urology for Clinicians(Electronic Version)
关键词
肾积水
肾结石
微创经皮肾镜取石术
结石清除率
危险因素
Hydronephrosis
Renal calculus
Minimally invasive percutaneous nephrolithotomy
Stone clearance rate
Risk factors
