CAJ | 학술논문

目的探讨Clavien-Dindo分级系统在经皮肾镜取石术(PCNL)并发症评估中的价值,分析PCNL并发症的相关危险因素. 方法回顾性分析2003年1月至2012年4月在本中心接受PCNL治疗并获随访的2 254例上尿路结石患者临床资料.男1 152例,女1 102例;年龄(43.7± 14.4)岁;体质指数(BMI)(21.9±3.2) kg/m2;结石表面积(302.1±314.1) mm2;鹿角形结石454例(20.14％).采用Clavien-Dindo分级系统对PCNL手术并发症进行分级,并采用Logistic多元回归方法分析其相关危险因素. 结果本组PCNL并发症发生率为26.22％(591例),其中Ⅰ、Ⅱ、Ⅲa、Ⅲb、Ⅳa、Ⅳb和Ⅴ级并发症发生率分别为8.07％(182例)、14.77％(333例)、1.86％(42例)、0.40％(9例)、0.75％(17例)、0.22％(5例)和0.13％(3例).最常见的并发症为出血,317例(14.06％)患者需输血;其次为术后发热(≥38.5 ℃),共130例(5.77％).多因素分析显示,发生Ⅱ级及以上并发症的影响因素包括BMI、术前血红蛋白、糖尿病、肾功能不全及肾积水程度、鹿角形结石、结石表面积、术中通道数量、分期手术、手术时间和碎石方式. 结论 Clavien-Dindo分级系统可相对客观地评价PCNL手术并发症.BMI、术前血红蛋白、糖尿病、肾功能不全及肾积水程度、鹿角形结石、结石表面积、术中通道数量、分期手术、手术时间和碎石方式是发生Ⅱ级及以上手术并发症的影响因素.
목적 탐토Clavien-Dindo분급계통재경피신경취석술(PCNL)병발증평고중적개치,분석PCNL병발증적상관위험인소. 방법 회고성분석2003년1월지2012년4월재본중심접수PCNL치료병획수방적2 254례상뇨로결석환자림상자료.남1 152례,녀1 102례;년령(43.7± 14.4)세;체질지수(BMI)(21.9±3.2) kg/m2;결석표면적(302.1±314.1) mm2;록각형결석454례(20.14％).채용Clavien-Dindo분급계통대PCNL수술병발증진행분급,병채용Logistic다원회귀방법분석기상관위험인소. 결과 본조PCNL병발증발생솔위26.22％(591례),기중Ⅰ、Ⅱ、Ⅲa、Ⅲb、Ⅳa、Ⅳb화Ⅴ급병발증발생솔분별위8.07％(182례)、14.77％(333례)、1.86％(42례)、0.40％(9례)、0.75％(17례)、0.22％(5례)화0.13％(3례).최상견적병발증위출혈,317례(14.06％)환자수수혈;기차위술후발열(≥38.5 ℃),공130례(5.77％).다인소분석현시,발생Ⅱ급급이상병발증적영향인소포괄BMI、술전혈홍단백、당뇨병、신공능불전급신적수정도、록각형결석、결석표면적、술중통도수량、분기수술、수술시간화쇄석방식. 결론 Clavien-Dindo분급계통가상대객관지평개PCNL수술병발증.BMI、술전혈홍단백、당뇨병、신공능불전급신적수정도、록각형결석、결석표면적、술중통도수량、분기수술、수술시간화쇄석방식시발생Ⅱ급급이상수술병발증적영향인소.
Objective To evaluate the Clavien-Dindo grading system (CDGS) in assessment of complications in percutaneous nephrolithotomy (PCNL),and to analyze the risk factors of complications in PCNL.Methods From January 2003 to April 2012,2 254 cases with calculus of upper urinary tract underwent PCNL in our center.There were 1 152 males and 1 102 females,with an average age of (43.7± 14.4) years,average body mass index (BMI) of (21.9±3.2) kg/m2,average stone surface area of (302.1± 314.1) mm2,and 454 (20.14％) cases of staghorn calculi.The complications in PCNL were evaluated by the CDGS,and the risk factors for complications in PCNL were analyzed by using multiple Logistic regression analysis.Results Among 591 (26.22％) cases with complications evaluated by CDGS,grades Ⅰ,Ⅱ,Ⅲa,Ⅲb,Ⅳa,Ⅳb and Ⅴ were 8.07％ (182 cases),14.77％ (333 cases),1.86％ (42 cases),0.40％ (9 cases),0.75％ (17 cases),0.22％ (5 cases) and 0.13％ (3 cases),respectively.Hemorrhage (317 cases,14.06％) was the most common complication,and followed by post-operative fever (130 cases,5.77％).Logistic regression analysis showed that the relevant risk factors of grade Ⅱ and higher complications mainly included BMI,pre-operative hemoglobin levels,diabetes mellitus,degrees of renal insufficiency and hydronephrosis,staghorn calculi,calculi surface area,intra-operative amounts of channels,staging operation,operation time and method of lithotripsy.Conelusions The CDGS can objectively evaluate the complications of PCNL.BMI,pre-operative hemoglobin levels,diabetes mellitus,degrees of renal insufficiency and hydronephrosis,staghorn calculi,calculi surface area,intra-operative amounts of channels,staging operation,operation time and method of lithotripsy are the risk factors for grade Ⅱ and higher complications of PCNL.