经皮肾镜碎石术治疗铸型结石术后结石残留的影响因素分析

Risk Factors Analysis for Residual Stones after Percutaneous Nephrolithotomy in Renal Staghorn Calculi Treatment

目的探讨经皮肾镜碎石术(PCNL)治疗铸型结石术后结石残留的影响因素及临床处理措施。方法回顾性分析PCNL治疗肾铸型结石患者83例。Ⅰ期结石清除率68.6%(57/83)。结石残留26例患者作为结石残留观察组,结石清除57例患者作为结石清除组,对比分析2组间可能影响PCNL术后结石残留的因素(结石大小、肾积水情况、术前泌尿系感染、肾脏既往手术史、术中是否出血、手术时间)的差异,找出可能影响结石残留的因素。结果结石大小(P=0.004)、肾脏既往手术史(P=0.001)、术中出血(P=0.016)和手术时间(P=0.035)对PCNL手术结石残留的影响具有统计学意义。结论术前明确结石大小及患者因既往手术造成的肾脏解剖结构异常情况,制定合理手术方案;术中平衡手术时间,尽可能取净结石;术后联合应用输尿管镜碎石术及体外震波碎石术,能有效提高PCNL结石清除率。

Objective To explore the risk factors affecting residual stones after percutaneons nephrolithotomy （PCNL） in the treatment of renal staghorn calculi, and discuss the clinical measures. Methods Clinical data of 83 staghorn calculi patients admitted in our hospital was retrospective- ly analyzed, including 26 patients with residual stones as residual stones observation group, and 57 cases of patients with no residual stones as the control group. Various factors （stone size, hydronephrosis cases, preoperative urinary tract infection, kidney previous surgery, and blood loss during operation, operative time ） were assessed for correlation with postoperative residual stones. Results Stone size （P = 0.004）, history of kidney previ- ous surgery （ P = 0.001 ）, blood loss during operation （ P = 0.016 ） operative time （P = 0.035 ） were the statistically significant risk factors for residu- al stones. Conclusion The stone-free rate can be improved by ascertaining stone size and previous surgery experience before operation, appropriately extending operation time, combine using of ESWL and/or URL.