影响肾结石行经皮肾镜术后清石率的多因素回归分析  

Multi-factor analysis of factors influencing the stone-free rate after percutaneous nephrolithotomy in kidney calculi

作　　者：钟隆飞[1] 李巧星[1] 梁东彦[1] 王勇[1] 王伟录[1] Zhong Longfei;Li Qiaoxing;Liang Dongyan;Wang Yong;Wang Weilu.(Department of Urology, the Kunshan Affiliated Hospital of Jiangsu University, Kunshan 215300, China)

机构地区：[1]江苏大学附属昆山医院泌尿外科,215300

出　　处：《中华腔镜泌尿外科杂志（电子版）》2018年第2期116-120,共5页Chinese Journal of Endourology(Electronic Edition)

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 anddistribution 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.

关 键 词：肾结石 经皮肾镜 清石率 

分 类 号：R699.2[医药卫生—泌尿科学]