PCNL术后并发肾萎缩危险因素的临床研究  

Clinical study of risk factors for the development of percutaneous nephrolithot-omy(PCNL) complicated by renal atrophy

作　　者：黄辉 何涛[1] 王彦[1] 黄文杰[1] 袁朝勇[1] HUANG Hui;HE Tao;WANG Yan;HUANG Wen-jie;YUAN Chao-yong(First People＇s Hospital of Zunyi, Urinary Surgery, Zunyi Guizhou 563002, Chin)

机构地区：[1]遵义市第一人民医院泌尿外科,贵州遵义563002

出　　处：《现代预防医学》2018年第12期2284-2287,共4页Modern Preventive Medicine

基　　金：遵义市科学技术局项目(编号:遵义科合社字[2013]08号)

摘　　要：目的探讨经皮肾镜碎石取石术(PCNL)后并发肾萎缩的影响因素,为预防肾萎缩发生提供临床资料。方法选取2012年1月-2016年1月因肾结石行PCNL术式患者923例,符合纳入及排除标准者878例,根据患者是否发生肾萎缩,分为肾萎缩组及非肾萎缩组,对影响PCNL术后肾萎缩的相关因素进行单因素分析,选取具有统计学差异的指标,进行多因素Logistic回归分析,判断危险因素与肾萎缩的相关性。结果 878例患者中发生肾萎缩者46例,其发生率为5.24%。单因素分析及多因素Logistic回归分析显示:灌注压力>30 mm Hg(OR=3.785,P=0.002,95%CI:1.614,8.877),肾中、重度积水(OR=4.329,P=0.001,95%CI:1.627,9.913)、结石位于肾盂交界处(OR=3.672,P=0.017,95%CI:1.254,7.652)、结石位于多肾盏(OR=4.239,P=0.001,95%CI:1.764,8.196)、肾积脓(OR=9.243,P=0.000,95%CI:2.014,17.518)是PCNL术后肾萎缩发生独立危险因素。结论 PCNL术后并发肾萎缩主要危险因素为肾积脓、中、重度肾积水、结石位于肾盂交界处及灌注压力增加,应针对以上危险因素制定预防措施,降低PCNL术后并发肾萎缩风险。Objective The aim of this study was to investigate the related risk factors for the development of percutaneous nephrolithotomy（PCNL） complicated by renal atrophy, and provide clinical data to reduce the renal atrophy. Methods The clinical data of 923 patients with renal calculus treated by PCNL in our hospital from January 2012 to January 2016 were retrospectively analyzed. According to the presence of renal atrophy, the patients were divided into two groups： renal atrophy group and non-renal atrophy group. The risk factors for the PCNL complicated by renal atrophy were evaluated. The relationship between the risk factors and the infections were determined through logistic regression analysis of each factors.Results 46 cases from 878 patients with PCNL were appeared to have renal atrophy, and the incidence was 5.24%. Single factor analysis and multi-factor logistic regression analysis showed that the perfusion pressure30 mm Hg（ OR=3.785, P=0.002, 95% CI：1.614, 8.877）, the kidney with severe hydronephrosis（OR=4.329, P=0.001, 95% CI： 1.627, 9.913）, located at the junction of renal pelvis calculi（OR=3.672, P=0.017, 95% CI： 1.254, 7.652）, the stones located in multiple renal valves（OR=4.239, P=0.001, 95% CI： 1.764, 8.196）, pyonephrosis（OR=9.243, P=0.000, 95% CI：2.014, 17.518） were risk factors of percutaneous nephrolithotomy complicated by renal atrophy. Conclusion Kidney with severe hydronephrosis, located at the junction of renal pelvis calculi, pyonephrosis and increasing perfusion pressure were major risk factors for percutaneous nephrolithotomy（PCNL） complicated by renal atrophy. Interventional measures should be made to deal with the risk factors in order to reduce the incidence of renal atrophy.

关 键 词：经皮肾镜碎石术 肾萎缩 LOGISTIC回归分析 危险因素 

分 类 号：R181.32[医药卫生—流行病学]