小儿微创经皮肾镜术后残留结石的危险因素分析

Risk factors analysis for residual stones after MPCNL for the treatment of upper urinary calculi in pediatric patients

目的研究分析导致小儿微创经皮肾镜（MPCNL）术后结石残留的相关危险因素。方法收集2009年1月至2014年11月在新疆维吾尔自治区人民医院泌尿外科行MPCNL治疗的患儿240例,根据Ⅰ期净石率分为结石清除组（202例）和结石残留组（38例）,对两组间可能影响MPCNL术后结石残留的危险因素进行统计学分析,找出影响结石残留的危险因素。结果240例接受MPCNL治疗的患儿,首次净石率为84.2%（202/240）。单因素分析发现结石位置（P=0.001）、结石大小（P=0.014）、结石数目（P=0.005）与患儿MPCNL术后首次净石率有显著相关性,而患儿年龄、性别、患侧、肾积水程度、尿路刺激症、肾绞痛、血尿、术前感染与MPCNL术后结石残留无明显相关性（P〉0.05）,多变量Logistic回归分析显示结石位置（OR=2.593,95%CI：1.228~5.475）、结石大小（OR=2.674,95%CI：1.290~5.540）、结石数目（OR=2.397,95%CI：1.145~5.019）与患儿MPCNL术后结石残留有显著的相关性。结论结石位置、大小及数目是导致患儿MPCNL治疗术后残留结石的重要危险因素,术前评估患儿病情,选择合适的治疗方案。

Objective To investigate factors affecting residual stones in pediatric patients with the upper urinary calculi undergoing minimally invasive percutaneous nephrolithotomy（MPCNL）and evaluate MPCNL curative effect before the operation.Methods A total of 240 children underwent MPCNL to remove the upper urinary calculi in People′s Hospital of Xinjiang Uygur Autonomous Region during the period of January 2009 to November 2014 were analyzed retrospectively.Pediatric patients were divided into two groups by the stone-free rate after the first operation：those who were stone-free after the first operation（n=202）as the control group and those who were residual stones（n=38）as residual stones observation group.Then the clinical data were statistically analyzed and find out risk factors which lead to residual stone.Results The stone-free rate after primary MPCNL was 84.2%（202/240）.Univariate analysis showed that stone size（P=0.001）,stone location（P=0.014）and number of stones（P=0.005）were significant factors which could affect residual stones between the two groups,while did not relate with gender,age,stone side,urinary irritation symptom,hematuria,renal colic,preoperative infection and the degree of hydronephrosis（P〉0.05）.Multivariate analysis showed that stone size（OR=2.593,95%CI：1.228-5.475）,stone location（OR=2.674,95%CI：1.290-5.540）and number of stones（OR=2.397,95%CI：1.145-5.019）were independent predictors of the surgical outcome.Conclusion Stone size,stone location and number of stones are significant factors affecting residual stones in pediatric patients with the upper urinary calculi undergoing MPCNL.According to the the clinical features of pediatric patients,we can chose suitable management of upper urinary tract calculi.