影响经皮肾镜取石术后结石清除率术前因素分析  

Preoperational factors affecting the stone-free rate after percutaneous nephrolithotripsy

作　　者：邵志强[1] 杨勇[1] 杨渝[1] 林茂虎[1] 王广健[2] 朱文彬[2] 郭丰富[2] 

机构地区：[1]中国人民解放军总医院第一附属医院泌尿外科,北京100048 [2]山东省临沂市人民医院泌尿外科

出　　处：《微创泌尿外科杂志》2014年第6期347-350,共4页Journal of Minimally Invasive Urology

基　　金：山东省医药卫生科技发展计划面上项目(2009HC016)

摘　　要：目的:探讨影响经皮肾镜取石术后结石清除率的术前因素。方法:回顾分析复杂性肾结石应用B超引导经皮肾镜取石术治疗的642例患者资料,男393例,女249例,平均年龄41(19~74)岁,术前均行B超、KUB(或IVU)及CT检查。治疗效果评估:结石完全清除或残余碎片≤4mm视为治疗成功(无石)。根据治疗结果分为无石组和残石组。应用χ2检验和t检验比较两组患者及结石特征如患者年龄、性别、身高、体重、体重指数、病程、结石负荷、数量、侧别、位置、原有尿路感染、肾积水、肾脏手术史等因素,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,找出对结石清除率有意义的因素。结果:结石清除率为82.2%(528/642),单因素分析显示两组体重指数、结石负荷、数量和位置差异有统计学意义。Logistic多因素回归分析排除体重指数、结石数量,结石负荷和位置是影响结石清除率有意义因素。结论:结石负荷和位置是影响PCNL术后结石清除率的独立因素,较大、混合型位置结石更易发生结石残留。Objective:Percutaneous nephrolithotripsy(PCNL)is the treatment choice for patients with extensive stone burden or stones refractory to extracorporeal shock wave lithotripsy.However,little is known about factors predicting unfavorably outcome in terms of stone-free rate.This study was performed to investigate the preoperational factors associated with the stone-free rate of PCNL for complex kidney stones.Methods:Between January 2012 and December 2013,a total of 642patients(393men and 249women;age range 19-74years;mean age 41years)with complex kidney stones were treated by PCNL with pneumatic and ultrasonic power under B-type ultrasound guidance.All cases were identified by KUB/IVU,type B ultrasonic and computed tomography.Patients' age,sex,height,weight,body mass index(BMI),duration of disease,stone burden,number,side,location,pre-existent urinary tract infection,hydronephrosis and previous kidney surgery were evaluated before PCNL,and treatment efficacies were evaluated at 3-5days after operation.Treatment success was correlated with stone features and patient characteristics using the chi square test and t-test.Factors found to be significant using the tests were further analyzed using multivariate regression analysis.Results:Using the chi square test and t-test,BMI,stone burden,number and location had significant impacts on the stone-free rate(P<0.05).Multivariate analysis excluded BMI and stone number from the logistic regression model,while the stone burden and stone location maintained statistically significant effect on success rate,indicating that there is independent predictor.Conclusions:This study demonstrated that stone burden and stone location were significant predictors of PCNL outcome,suggesting that large stone of mixed location is associated with low stone-free rate.

关 键 词：肾石病 经皮肾镜取石术 无石率 短期疗效 

分 类 号：R699.2[医药卫生—泌尿科学]