中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
44期
3617-3619
,共3页
肾结石%经皮肾镜碎石手术%结石残留%影响因素
腎結石%經皮腎鏡碎石手術%結石殘留%影響因素
신결석%경피신경쇄석수술%결석잔류%영향인소
Renal calculus%Percutaneous nephrolithotomy%Residual stone%Prognostic factor
目的 探讨影响肾结石患者经皮肾镜碎石取石术(PCNL)术后结石残留的因素.方法 对2008年1月至2014年5月间河南省安阳市人民医院泌尿外科施行经皮肾镜碎石取石手术的1 200例肾结石患者进行回顾性分析.在这些患者中,有16例患者为双肾结石,先后两次行PCNL手术.将结石大小、结石位置、结石数目、既往肾结石手术史、肾盂积水程度、有无尿路感染史等指标作为可变因素进行单变量及多变量分析,以确定可能影响术后结石残留的因素.结果 1200例患者中,共有385例患者出现术后结石残留,发生率为31.7%.单因素分析结果显示,肾盂合并多个肾盏结石(P =0.006)、结石＞4 cm(P =0.005)、结石数目＞4个(P=0.002)、术中出血量＞200 ml(P=0.025)、手术时间＞120 min(P=0.028)与术后结石残留密切相关.而多变量分析显示,只有肾盂合并多个肾盏结石(P =0.049)、结石＞4 cm(P =0.038)、结石数目＞4个(P=0.018)仍保持为术后结石残留的独立预后因素.结论 结石大小、结石数目、结石位置等因素对于PCNL术后结石残留具有重要预后价值,较大结石以及肾盂合并多个肾盏结石与术后结石残留密切相关,而结石数目少于4个预示术后结石清除率明显升高.
目的 探討影響腎結石患者經皮腎鏡碎石取石術(PCNL)術後結石殘留的因素.方法 對2008年1月至2014年5月間河南省安暘市人民醫院泌尿外科施行經皮腎鏡碎石取石手術的1 200例腎結石患者進行迴顧性分析.在這些患者中,有16例患者為雙腎結石,先後兩次行PCNL手術.將結石大小、結石位置、結石數目、既往腎結石手術史、腎盂積水程度、有無尿路感染史等指標作為可變因素進行單變量及多變量分析,以確定可能影響術後結石殘留的因素.結果 1200例患者中,共有385例患者齣現術後結石殘留,髮生率為31.7%.單因素分析結果顯示,腎盂閤併多箇腎盞結石(P =0.006)、結石＞4 cm(P =0.005)、結石數目＞4箇(P=0.002)、術中齣血量＞200 ml(P=0.025)、手術時間＞120 min(P=0.028)與術後結石殘留密切相關.而多變量分析顯示,隻有腎盂閤併多箇腎盞結石(P =0.049)、結石＞4 cm(P =0.038)、結石數目＞4箇(P=0.018)仍保持為術後結石殘留的獨立預後因素.結論 結石大小、結石數目、結石位置等因素對于PCNL術後結石殘留具有重要預後價值,較大結石以及腎盂閤併多箇腎盞結石與術後結石殘留密切相關,而結石數目少于4箇預示術後結石清除率明顯升高.
목적 탐토영향신결석환자경피신경쇄석취석술(PCNL)술후결석잔류적인소.방법 대2008년1월지2014년5월간하남성안양시인민의원비뇨외과시행경피신경쇄석취석수술적1 200례신결석환자진행회고성분석.재저사환자중,유16례환자위쌍신결석,선후량차행PCNL수술.장결석대소、결석위치、결석수목、기왕신결석수술사、신우적수정도、유무뇨로감염사등지표작위가변인소진행단변량급다변량분석,이학정가능영향술후결석잔류적인소.결과 1200례환자중,공유385례환자출현술후결석잔류,발생솔위31.7%.단인소분석결과현시,신우합병다개신잔결석(P =0.006)、결석＞4 cm(P =0.005)、결석수목＞4개(P=0.002)、술중출혈량＞200 ml(P=0.025)、수술시간＞120 min(P=0.028)여술후결석잔류밀절상관.이다변량분석현시,지유신우합병다개신잔결석(P =0.049)、결석＞4 cm(P =0.038)、결석수목＞4개(P=0.018)잉보지위술후결석잔류적독립예후인소.결론 결석대소、결석수목、결석위치등인소대우PCNL술후결석잔류구유중요예후개치,교대결석이급신우합병다개신잔결석여술후결석잔류밀절상관,이결석수목소우4개예시술후결석청제솔명현승고.
Objective To explore the factors affecting the residual stones after percutaneous nephrolithotomy (PCNL) in patients with renal calculus.Methods A retrospective analysis was performed for 1 200 patients who were affected by renal calculus and treated with PCNL between Jan 2008 and May 2014 in People's Hospital of Anyang City.Among those patients, 16 were diagnosed as bilateral renal stone and had two successive operations.The size, location and number of stones, previous history of surgery, the degree of hydronephrosis, urinary infection were included in the univariate analysis.Significant factors in univariate analysis were included in the multivariate analysis to determine factors affecting stone residual.Results A total of 385 cases developed stone residual after surgery.The overall residual rate was 31.7%.In univariate analysis, renal pelvis combined with caliceal calculus (P =0.006), stone size larger than 4 cm (P =0.005), stone number more than 4 (P =0.002), the amount of bleeding more than 200 ml (P =0.025), operation time longer than 120 minutes (P =0.028) were associated with an increased rate of stone residual.When subjected to the Cox multivariate analysis, the independent risk factors for residual stones were renal pelvis combined with caliceal calculus (P =0.049), stone size larger than 4 cm (P =0.038) and stone number more than 4 (P =0.018).Conclusions Factors affecting the incidence of residual stones after PCNL are the size, location and number of stones.Larger size stone and the presence of renal pelvis combined with caliceal calculus are significantly associated with residual stones.Nevertheless, stone number less than 4 indicates an increased stone clearance rate.
