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目的微创经皮肾镜取石术是治疗肾结石的常用方法之一,但是术后常出现肾结石残留,探讨其影响因素,可对减少术后结石残留提供科学的指导。方法回顾性分析2013年6月—2015年6月收治的肾结石患者372例,均行微创经皮肾镜取石术,根据术后是否有结石残留,分为观察组(结石残留)132例和对照组(结石无残留)240例,收集并记录2组患者的性别、年龄、BMI、合并糖尿病、合并高血压、肾功能不全、孤立肾、肾积水程度、肾盂类型、穿刺肾盏位置、通道数量、肾皮质厚度、鹿角形结石、结石负荷、手术时间及术中出血量,并对2组患者的观察指标行单因素和多因素非条件Logistic回归分析。结果 132例患者术后复查发现仍有结石残留,结石残留率为35.5%,通过单因素分析2组患者的观察指标,发现与微创经皮肾镜取石术术后结石残留的相关因素主要有肾功能不全、肾盂类型、通道数量、鹿角型结石、结石负荷及手术时间(P<0.05);进一步应用多因素非条件Logistic回归分析结果显示,术前患者合并有肾功能不全、分枝型肾盂、结石负荷>1 000及鹿角型结石显著增加微创经皮肾镜取石术术后结石残留的风险(P<0.05)。结论合并有肾功能不全、分枝型肾盂、结石负荷>1 000及鹿角型结石是微创经皮肾镜取石术术后结石残留的独立风险因素,术前应重点评估患者的肾功能、结石情况及肾解剖结构,采取相应措施,尽可能减少术后结石残留率。
【Objective】 Minimally invasive percutaneous nephrolithotomy is one of the commonly used methods for the treatment of renal calculus. However, the residual renal stones often appear after operation, and the influencing factors are discussed, which can provide scientific guidance for reducing postoperative residual stones. Methods A retrospective analysis of 372 patients with nephrolithiasis admitted from June 2013 to June 2015 were performed minimally invasive percutaneous nephrolithotomy. According to the presence or absence of stones after operation, the patients were divided into observation group (residual stone) 132 cases And control group (no residual stones) 240 cases were collected and recorded two groups of patients sex, age, BMI, with diabetes, hypertension, renal insufficiency, isolated kidney, hydronephrosis, renal pelvis type, puncture calyx position , The number of channels, the thickness of renal cortex, antler stone, stone load, operation time and intraoperative blood loss, and the two groups of patients were observed by single factor and multivariate non-conditional Logistic regression analysis. Results 132 cases of postoperative recheck found that there are still residual stones, the residual rate of stones was 35.5%. By univariate analysis of the observation of two groups of patients and found that after minimally invasive percutaneous nephrolithotomy lithotomy residual stones related factors are Renal insufficiency, renal pelvis type, the number of channels, antlers type stone, stone load and operation time (P <0.05); further use of multivariate non-conditional logistic regression analysis showed that preoperative patients with renal insufficiency, , Stone load> 1 000 and antler type stone significantly increased the risk of residual stones after minimally invasive percutaneous nephrolithotomy (P <0.05). Conclusions The combined renal insufficiency, branch type renal pelvis, stone load> 1000 and antler type stone are minimally invasive percutaneous nephrolithotomy residual stone independent risk factors, preoperative evaluation should focus on patients with renal function, stones Situation and renal anatomy, take appropriate measures to minimize postoperative residual stone ratio.