肾功能正常与肾功能不全患者行经皮肾镜取石术的对照研究

Percutaneous nephrolithotomy in patients with normal versus impaired renal function

目的比较肾功能正常与肾功能不全患者接受经皮肾镜取石术后的转归及并发症情况,以提高临床认识。方法回顾性分析2005年12月至2012年12月接受经皮肾镜取石术的慢性肾功能不全病例,共92例患者,选取同期住院接受经皮肾镜取石术的肾功能正常患者92例作为对照,统计比较平均手术时间、住院天数、手术并发症等。结果肾功能不全患者平均手术时间(101.89±46.75)min、平均住院天数(21.79±9.71)d、严重出血(需要输血或介入治疗)发生率22.9%,明显高于对照组的(84.12±44.50)min、(15.96±6.57)d、2.2%(P<0.005);清石率为56.5%,明显低于对照组的80.4%(P<0.005)。原因主要是结石负荷大以及可能存在的凝血机制受损。结论慢性肾功能不全患者手术风险明显高于对照组,出血并发症发生率高,建议由有经验的医师实施手术。

ObjectiveTo compare the postoperative outcomes and complications of patients with normal renal function and renal insufficiency who received percutaneous nephrolithotomy. MethodsData of 92 patients with renal insufficiency who underwent percutaneous nephrolithotomies during Dec. 2005 to Dec. 2012 were retrospectively analyzed, and 92 patients with normal renal function who received percutaneous nephrolithotomy in the same period were chosen as controls. The average operation time, hospitalization days, surgical complications were statistically analyzed. ResultsThe mean operation time, average hospitalization days and severe bleeding incidence （needs blood transfusion or interventional treatment） was （101.89±46.75）minutes, （21.79±9.71）days and 22.9% in renal insufficiency group, significantly higher than those of the control group, which were （84.12±44.50）minutes, （15.96±6.57）days and 2.2% （P＜0.005）. The stone clearance rate was 56% in the renal insufficiency group and 80.4% in the control group, with significant difference （P＜0.005）, which might be explained that renal insufficiency caused greater stone burden and possible damage on blood coagulation. ConclusionsThe operation risk is higher in patients with chronic renal insufficiency. Therefore, percutaneous nephrolithotomy in patients with chronic renal insufficiency should be performed by experienced doctors. 