肾结石患者经皮肾镜碎石术后结石残留影响因素分析

Factors affecting residual stones after percutaneous nephrolithotomy in patients with renal calculus

目的探讨影响肾结石患者经皮肾镜碎石取石术（PCNL）术后结石残留的因素。方法对2008年1月至2014年5月间河南省安阳市人民医院泌尿外科施行经皮肾镜碎石取石手术的1200例肾结石患者进行回顾性分析。在这些患者中，有16例患者为双肾结石，先后两次行PCNL手术。将结石大小、结石位置、结石数目、既往肾结石手术史、肾盂积水程度、有无尿路感染史等指标作为可变因素进行单变量及多变量分析，以确定可能影响术后结石残留的因素。结果1200例患者中，共有385例患者出现术后结石残留，发生率为31．7％。单因素分析结果显示，肾盂合并多个肾盏结石（P=0．006）、结石〉4cm（P=0．005）、结石数目〉4个（P=0．002）、术中出血量〉200ml（P=0．025）、手术时间〉120min（P=0．028）与术后结石残留密切相关。而多变量分析显示，只有肾盂合并多个肾盏结石（P=0．049）、结石〉4cm（P=0．038）、结石数目〉4个（P=0．018）仍保持为术后结石残留的独立预后因素。结论结石大小、结石数目、结石位置等因素对于PCNL术后结石残留具有重要预后价值，较大结石以及肾盂合并多个肾盏结石与术后结石残留密切相关，而结石数目少于4个预示术后结石清除率明显升高。

Objective To explore the factors affecting the residual stones after percutaneous nephrolithotomy （PCNL） in patients with renal calculus. Methods A retrospective analysis was performed for 1 200 patients who were affected by renal calculus and treated with PCNL between Jan 2008 and May 2014 in People＇s Hospital of Anyang City. Among those patients, 16 were diagnosed as bilateral renal stone and had two successive operations. The size, location and number of stones, previous history of surgery, the degree of hydronephrosis, urinary infection were included in the univariate analysis. Significant factors in univariate analysis were included in the multivariate analysis to determine factors affecting stone residual. Results A total of 385 cases developed stone residual after surgery. The overall residual rate was 31.7%. In univariate analysis, renal pelvis combined with caliceal calculus （ P = 0. 006）, stone size larger than 4 cm （P = 0. 005） , stone number more than 4 （ P = 0. 002 ） , the amount of bleeding more than 200 ml （ P = 0. 025 ）, operation time longer than 120 minutes （ P = 0. 028 ） were associated with an increased rate of stone residual. When subjected to the Cox multivariate analysis, the independent risk factors for residual stones were renal pelvis combined with caliceal calculus （ P = 0. 049 ）, stone size larger than 4 cm （ P = 0. 038 ） and stone number more than 4 （P = 0. 018 ）. Conclusions Factors affecting the incidence of residual stones after PCNL are the size, location and number of stones. Larger size stone and the presence of renal pelvis combined with caliceal calculus are significantly associated with residual stones. Nevertheless, stone number less than 4 indicates an increased stone clearance rate.