肾结石患者PCNL术后结石残留的相关影响因素分析

Factors Relate to Postoperative Renal Stone Residue in Patients with Precutaneous Nephrolithotomy

【目的】探讨肾结石患者经皮肾镜取石术（PCNL）术后结石残留的相关影响因素。【方法】选取2014年2月至2016年4月本院收治的279例肾结石患者的临床资料，所有患者均行PCNL术治疗，记录所有患者术后结石残留情况，并对患者术后结石残留的相关影响因素进行单因素方差分析，对有统计学意义的相关影响因素行多因素Logistic回归分析。【结果1279例肾脏结石患者手术清除率83．15％，残留率为16．85％。结石直径〉1．0cm、混合结石、结石负荷〉700mm2、鹿角形结石、多个结石、肾功能不全、手术时间〉60min患者的结石残留率明显高于其他患者，差异具有统计学意义（P〈0.05）。经多因素Logistic回归分析发现结石直径〉1．0cm、混合结石、结石负荷〉700mm2、鹿角形结石、多个结石、肾功能不全是影响肾脏结石患者手术后结石残留的危险因素（P〈0．05）。【结论】肾结石患者术后存在结石残留风险，其中混合结石、鹿角形结石、多个结石、肾功能不全、结石直径和负荷过大均是影响肾结石患者PCNL术后结石残留的危险因素，对此临床工作者应引起高度重视。

[Objective]To explore the influencing factors of postoperative kidney stone residue in patients after percu taneous nephrolithotomy （PCNL） surgery.[Methods]A total of 279 patients with renal stones from February 2014 to A- pril 2016 in our hospital were selected as the subject. All underwent percutaneous nephrolithotomy and postoperative kid- ney stone residue in each case was recorded. Stone residue and its related clinical data were analyzed by univariate and mul- tivariate logistic regression analysis. [Results]The kidney stones in the 279 patients showed a surgical removal rate of 83.15% and a residual rate of 16.85 %. Stone residual rate in patients with stone diameter〉 1.0cm, mixed stones, stones load 〉 700mm2 , staghorn stones, multiple stones, renal insufficiency, and operative time〉 60 min was significantly higher than that in patients without the above symptoms; the difference was statistically significant （ P 〈0.05 ）. Based on multivariate logistic regression analysis, independent risk factors for renal stone residue after PCNL were stone diame- ter 〉1.0cm, mixed stones, stones load 〉 700mm2 , staghorn stones, multiple stones, and renal dysfunction （ P〈0. 05）. [Conclusion]There is a risk of residual kidney stones in patients after PCNL surgery. The influencing factors are stone diameter, stone load, presence of mixed stones, staghorn calculi, multiple stones, and renal dysfunction. Therefore, these independent risk factors should be paid more intention to kidney stone patients.