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目的:分析影响微创经皮肾取石术(mPCNL)清石效果的相关因素。方法:2009年1月~2015年11月实施mPCNL共计258例,对其年龄、性别、体重指数、高血压、糖尿病、肾脏既往手术史、患肾侧别、结石长径、数目、表面积、所占肾盏数、肾积水程度、术者经验(术者完成mPCNL的例数)与结石清除率之间的关系进行分析,找出影响清石效果的主要因素。结果:本组Ⅰ期结石清除率为73.25%(189/258)。单因素分析显示结石长径、数目、表面积、所占肾盏数、肾积水程度、术者完成mPCNL例数六项因素与结石清除率之间的差异有统计学意义(P<0.05);而年龄、性别、体质指数、是否合并高血压、是否合并糖尿病、肾脏既往手术史、患肾侧别与结石清除率之间的差异均无统计学意义。Logistic回归分析显示:影响Ⅰ期mPCNL术后结石清除率的因素是结石长径、数目、表面积、所占肾盏数及肾积水程度。结论:结石越大、多发、所占肾盏数越多、肾积水程度越重,术后结石残留的可能性也越大。
Objective: To analyze the related factors that affect the effect of minimally invasive percutaneous nephrolithotomy (mPCNL). Methods: From January 2009 to November 2015, a total of 258 mPCNL patients were enrolled in this study. Their age, sex, body mass index, hypertension, diabetes mellitus, history of previous renal surgery, kidney size, number of long diameter of stone, number, Accounting for the number of calyces, hydronephrosis, the experience of the surgeon (the number of patients completed mPCNL) and the relationship between stone clearance rate analysis to identify the main factors affecting the effect of clear stones. Results: The group Ⅰ stone clearance rate was 73.25% (189/258). Univariate analysis showed that there was a significant difference between the six factors of stone length and number of stones, the number of surface area, the number of calyceal and the degree of hydronephrosis, the number of mPCNL cases completed by the surgeon and stone clearance rate (P <0.05). Age, gender, body mass index, whether with hypertension, with or without diabetes, history of previous renal surgery, and no difference between the side of the kidney and stone clearance rates were not statistically significant. Logistic regression analysis showed that the factors influencing the rate of stone removal after stage I mPCNL were the longest diameter of the stone, the number, the surface area, the number of renal calyces and the degree of hydronephrosis. Conclusion: The larger and more stones, the greater the number of renal calories, the more severe hydronephrosis, the greater the possibility of postoperative residual stones.