CAJ | 학술논문

目的探讨鹿角形肾结石分支数对经皮肾镜取石术(PNL)结果的影响.方法回顾性分析2009年1月至2013年1月371例患者(386侧)鹿角形肾结石的CT三维重建(3-DR)资料和经皮肾镜取石术结果.纳入标准为结石分支数≥2,排除标准为解剖结构异常(如马蹄肾、异位肾等)肾结石.根据3-DR记录结石的分支数,并按分支数将患肾分为4组:第1组分支数2～4,第2组分支数5～7,第3组分支数8～ 10,第4组分支数＞10.对组间皮肾通道数、手术时间、失血量、分期手术、净石率、术后住院天数及并发症进行比较.结果 371例患者(386侧患肾)均成功完成PNL手术.其中单通道手术144侧,多通道242侧.一期手术289侧,分期手术97侧.平均手术时间(100±50) min,平均失血量(83±67)ml,净石率为61.7％(术后3d)、79.5％(术后3个月).术后平均住院时间(6.9±3.4)d.统计结果显示,当结石分支数≥5时,PNL过程中使用多通道的几率增加(x2=212.220,P＜0.01),分期手术的几率亦增加(x2=49.679,P＜0.01),且手术时间延长(F =4.652,P＜0.01),术后住院天数增加(F =2.067,P =0.043),净石率降低(x2=10.691、47.369,P＜0.05).使用改进的Clavien分级系统评估并发症无明显差异(P =0.460).结论鹿角形肾结石分支数≥5时,多通道及分期PNL的可能性增加,净石率下降,住院天数延长.
목적 탐토록각형신결석분지수대경피신경취석술(PNL)결과적영향.방법 회고성분석2009년1월지2013년1월371례환자(386측)록각형신결석적CT삼유중건(3-DR)자료화경피신경취석술결과.납입표준위결석분지수≥2,배제표준위해부결구이상(여마제신、이위신등)신결석.근거3-DR기록결석적분지수,병안분지수장환신분위4조:제1조분지수2～4,제2조분지수5～7,제3조분지수8～ 10,제4조분지수＞10.대조간피신통도수、수술시간、실혈량、분기수술、정석솔、술후주원천수급병발증진행비교.결과 371례환자(386측환신)균성공완성PNL수술.기중단통도수술144측,다통도242측.일기수술289측,분기수술97측.평균수술시간(100±50) min,평균실혈량(83±67)ml,정석솔위61.7％(술후3d)、79.5％(술후3개월).술후평균주원시간(6.9±3.4)d.통계결과현시,당결석분지수≥5시,PNL과정중사용다통도적궤솔증가(x2=212.220,P＜0.01),분기수술적궤솔역증가(x2=49.679,P＜0.01),차수술시간연장(F =4.652,P＜0.01),술후주원천수증가(F =2.067,P =0.043),정석솔강저(x2=10.691、47.369,P＜0.05).사용개진적Clavien분급계통평고병발증무명현차이(P =0.460).결론 록각형신결석분지수≥5시,다통도급분기PNL적가능성증가,정석솔하강,주원천수연장.
Objective To investigate the impact of staghorn stone branch number on outcomes of percutaneous nephrolithotomy (PNL).Methods From January 2009 to January 2013,the 371 patients with staghorn stones who were referred to our hospital for PNL were considered for this study.All calculi were showed with CT 3-dimentional reconstruction (3-DR) imaging.The computerized database of the patients had been reviewed.Our exclusion criterion was patients with congenital renal anomalies,such as horse-shoe and ectopic kidneys.And borderline stones that branched to one major calyx only were also not included.From 3-DR images,the number of stone branching into minor renal calices was recorded.We made "3" as the branch breakdown between groups.And the patients were divided into four groups.The number of percutaneous tract,operative time,staged PNL,intra-operative blood loss,complications,stone clearance rate,and postoperative hospital day were compared.Results The 371 patients (386 renal units)underwent PNL successfully,included 144 single-tract PNL,242 multi-tract PNL,97 staged PNL.The average operative time was (100±50) minutes; the average intra-operative blood loss was (83 ± 67) ml.The stone clearance rate were 61.7％ (3 days) and 79.5％ (3 months).The postoperative hospital stay was (6.9 ± 3.4) days.A significantly higher ratio of multi-tract (x2 =212.220,P ＜ 0.01) and staged PNL (x2 =49.679,P ＜ 0.01),longer operative time (F =4.652,P ＜ 0.01) and postoperative hospital day (F =2.067,P =0.043) and lower rate of stone clearance (x2 =10.691 and 47.369,P ＜ 0.05) were found in PNL for calculi with stone branch number ≥ 5.There was no statistically meaningful difference among the 4 groups based on Clavien complication system (P =0.460).Conclusion The possibility of multi-tract and staged PNL,lower rate of stone clearance and longer postoperative hospital day increase for staghorn calculi with stone branch number more than 5.