摘要
目的:分析孤立肾肾结石行经皮肾镜碎石术后导致肾功能恶化的危险因素。方法:回顾性分析2008年9月-2013年12月本院收治的孤立肾肾结石患者,并同期行经皮肾镜碎石取石术,排除随访时间不足一年者,记录并发症、二次手术及净石率,比较手术前后的肾小球滤过率判断肾功能的改变,术前、术中及术后的相关因素通过单因素分析和多因素分析的方法,明确导致肾功能恶化的危险因素。结果:本研究共58例患者,其中男39例(67.2%),女19例(32.8%),平均年龄为(55.7±11.2)岁,并发症发生率为13.8%(8/58),3例(5.2%)患者出现严重出血,净石率为86.2%(50/58),术后肾小球滤过率(61.0±18.2)m L/min较术前(53.0±16.7)m L/min明显改善(P<0.01),7例(12.1%)患者出现肾功能恶化,在单变量分析中,慢性肾脏病分期、多通道取石、严重出血及结石残留均为肾功能恶化的相关危险因素(P<0.05);在多变量分析中,多通道取石及严重出血均为肾功能恶化的独立危险因素(P<0.05)。结论:依据长期随访结果,经皮肾镜碎石术能显著改善孤立肾的肾功能,多通道取石及严重出血为导致肾功能恶化的独立危险因素。
Objective： To analyze the risk factors of percutaneous nephrolithotomy （ PCNL ） for solitary kidney stones leading to deterioration of renal function.Method： Patients with solitary kidney stones who underwent PCNL in our hospital from September 2008 to December 2013 were retrospectively analyzed.Patients with follow-up 〈1 year were excluded.The complications, secondary procedures and stone-free rates were recorded.The glomerular filtration rate to determine the changes of renal function for preoperative and postoperative were compared.Preoperative, intraoperative and postoperative factors that might affect renal function were tested by univariate and multivariate analysis to define risk factors for deterioration of renal function on long-term follow-up.Result： The study included 58 patients, there were 39 men and 19 women, the mean age was （ 55.7 ± 11.2 ） years.The incidence rate of complications was 13.8% （ 8/58 ） .Severe bleeding occurred in 3 patients （ 5.2% ） .The overall stone- free rate was 86.2%.After long-term follow-up, the glomerular filtration rate postoperative was （ 61.0 ± 18.2 ） mL/min, which was significantly improved compared with （ 53.0 ±16.7 ） mL/min of the preoperative （ P〈0.01 ） .7 patients （ 12.1% ） showed deterioration of the renal function.In the univariate analysis, chronic kidney disease stages, multiple punctures, severe bleeding and residual calculus were related risk factors for renal function deterioration （ P〈0.05 ） .In the multivariate analysis, multiple punctures and severe bleeding were independent risk factors for renal function deterioration （P〈0.05） .Conclusion： Based on long-term follow-up results, PCNL can significantly improve the renal function of solitary kidney.Multiple punctures and severe bleeding are independent risk factors for deterioration of the kidney function.
出处
《中国医学创新》
CAS
2015年第23期58-61,共4页
Medical Innovation of China
关键词
经皮肾镜
孤立肾
肾功能
危险因素
Percutaneous nephrolithotomy
Solitary kidney
Renal function
Risk factors
