微创经皮肾穿刺取石术治疗复杂性肾结石的术后并发症危险因素分析  

Multivariate analysis of related risk factors of postoperative complications of minimally invasive percutaneous nephrolithotomy for complex renal calculi

作　　者：廖春贤[1] 华庆生[1] 石宇强[1] 王永刚[2] 

机构地区：[1]佛山市顺德区第一人民医院泌尿外科,广东佛山528300 [2]吉林大学中日联谊医院泌尿外科

出　　处：《中国实验诊断学》2017年第3期468-470,共3页Chinese Journal of Laboratory Diagnosis

基　　金：吉林省财政厅资助课题(SCZSY201620)

摘　　要：目的探讨微创经皮肾穿刺取石术治疗复杂性肾结石术后并发症发生情况及相关危险因素分析。方法回顾性分析260例于2012年4月-2016年4月在我科行微创经皮肾穿刺取石术治疗复杂性肾结石病例的临床资料,随访术后60天内发生的并发症。采用单因素和多因素回归分析法,分析复杂性肾结石术后并发症发生的相关危险因素。结果出现并发症的病例数为38例,发生率为14.6%。术后并发症包括:肾出血7例(2.7%)、胸膜损伤3例(1.2%)、结肠损伤1例(0.4%)、术后尿路感染24例(9.2%)、肾周尿外渗3例(1.2%)。多因素logistic分析显示,手术时间[P<0.001,OR=2.957,CI(1.056-3.546)]、结石大小[P<0.001,OR=2.452,CI(1.021-3.148)]和术前尿路感染[P=0.022,OR=1.459,CI(1.020-5.847)]是发生并发症的独立影响因素。结论手术时间、结石大小和术前尿路感染是影响复杂性肾结石行微创经皮肾穿刺取石术后并发症的独立危险因素,充分术前准备,规范操作,尽量减短手术时间,是防止微创经皮肾穿刺取石术后并发症有效措施。Objective To investigate the complications and risk factors of minimally invasive pereutaneous nephrolithotomy in complex renal calculi. Methods Clinical data of 260 patients with complex renal calculi receiving minimally invasive percutaneous nephrolithotomy from April 2012 to April 2016 in our hospital were analyzed. Postoperative complications were followed and were recorded. Possible risk factors pertaining to the development of complications were identified using univariate and multivariate analysis. Results Postoperative complications occurred in 38 of 260 patients（ 14.6 % ）, which included renal hemorrhage in 7 cases （2.7 % ）, pleural injury in 3 cases （ 1.2 % ）, colon injury in 1 cases （0.4 % ）, postoperative urinary tract infection in 24 cases （9.2 %） and perirenal extravasation of urine in 3 cases （ 1.2 % ）. The multivariate logistic regression analysis identified that operative time [P〈0. 001, OR= 2. 957, CI （ 1. 056- 3. 546）], stone size [P〈0. 001, OR= 2. 452, CI （1. 021-3. 148）] and preoperative urinary tract infection [P = 0. 022, OR= 1. 459, CI （1. 020-5. 847）] were the independent risk factors for development of complications after minimally percutaneous nephrolithotomy for complex renal calculi. Conclusion operative time,stone size and preoperative urine bacterial culture are the independent risk factors for development of complications after minimally percutaneous nepbrolithotomy for complex renal calculi. Adequate preopreparation, standard operation and shortening operation time are critical important to prevent occurrence of complications.

关 键 词：复杂性肾结石 微创经皮肾镜取石术 术后并发症 危险因素 

分 类 号：R699.2[医药卫生—泌尿科学]