PCNL治疗不同年龄组肾结石单中心研究

Single-center study of percutaneous nephrolithotomy(PCNL)for treatment kidney stones in different age groups

目的通过单中心大样本资料探讨不同年龄组肾脏生长变化特点对经皮肾镜取石术(PCNL)手术操作的影响。方法搜集2012年4月-2017年3月收治于新疆医科大学第一附属医院各年龄组肾及输尿管上段结石患者的临床资料,年龄分组如下,Ⅰ组:0~3岁,Ⅱ组:4~7岁,Ⅲ组:8~14岁,Ⅳ组:≥14岁。记录数据包括:结石负荷及位置,肾穿刺位点、肾造瘘通道大小及数量、手术时间(min)、清石率、并发症。使用方差分析以及趋势性卡方检验对不同年龄组数据构成比进行分析。结果收集上尿路结石患者1 216例共计手术肾单元1 273个,Ⅰ组93个(7.3%)、Ⅱ组41个(3.2%)、Ⅲ组36个(2.8%)、Ⅳ组1 103个(86.6%)。所有患者经一期PCNL术。穿刺点位于12肋下的例数分别是:Ⅰ组90例(96.8%)、Ⅱ组21例(51.2%)、Ⅲ组8例(19.5%)、Ⅳ组217例(18.0%),其余在11~12肋间穿刺。随着年龄的增大,穿刺位置越来越靠近第11~12肋间(χ_(MH)~2=283.553,P=0.000)。平均穿刺通道:Ⅰ组(14±0.00)F、Ⅱ组(15.6±0.80)F、Ⅲ组(21.3±3.62)F、Ⅳ组(22.1±3.12)F,Ⅲ组和Ⅳ组通道大小差异无统计学意义(F=43.576,P=0.122),其余各组之间对比通道大小差异有统计学意义(F=260.064,P=0.000),Ⅰ~Ⅳ组平均手术时间分别为33.3、39.2、54.7、79.5min,清石率分别为96.7%、87.8%、83.3%、77.7%,主要并发症发生率分别为1.1%、0.0%、5.7%、4.5%,次要并发症发生率分别为10.3%、20.5%、20.0%、18.0%,随着年龄组增大,PCNL手术时间逐渐延长,清石率逐渐下降(χ_(MH)~2=208.173,P=0.000),并发症有增多的趋势(χ_(MH)~2=11.866,P=0.001)。结论 PCNL手术可以安全地用于任何年龄段人群,随着肾脏生长特点变化,PCNL操作细节方面发生相应的变化,年龄越小,尤其是3岁以下年龄组,PCNL治疗综合获益越大。

Objective To investigate the effects of percutaneous nephrolithotomy（PCNL）technique details changing with renal growth in different age group from single center large sample data.Methods Patients with renal stones who underwent PCNL in our clinic from April 2012 to March 2012 were assessed.According to different age,four groups（Ⅰ：0-3 years of age,Ⅱ：4 to 7 years old,Ⅲ：8 to 14 years old,Ⅳ：≥14）were composed and the following outcomes（Stone burden and position,puncture site,nephroscope size;Operation time;Stone-free rates and complications）were compared using variance and trend chi-square.Results PCNL was applied to treat 1273 renal units of 1216 patients,which respectively distributed in Ⅰ-Ⅳ groups：93（7.3%）,41（3.2%）,36（2.8%）,1103（86.6%）.The puncture point located under 12 ribs were as follows,Ⅰ：90 cases（96.8%）,Ⅱ：21 cases（51.2%）,Ⅲ：8 cases（19.5%）,Ⅳ：217 cases（18.0%）,the rest puncture point was between 11-12 ribs.The puncture position tend to close11-12 ribs with increase of age（χMH^2=283.553,P =0.000）.The distribution of nephroscope size in different age groups wereⅠ：（14±0.00）F,Ⅱ：（15.6±0.80）F,Ⅲ：（21.3±3.62）F,Ⅳ：（22.1±3.12）F.There was a statistically significant difference in channel size between the other groups（F=260.064,P =0.000）,except for Ⅲ and Ⅳ（F =43.576,P =43.576）.From Ⅰ to Ⅳ group,the average operation time was 33.3,39.2,54.7,79.5 min,Stone-free rates is 96.7%,87.8%,83.3% and 87.8% respectively,the main complications were 1.1%,0.0%,5.7%,4.5%,minor complications were 10.3%,20.5%,20.0%,18.0%,respectively.With the age increasing,PCNL operation time and complications increased gradually（χMH^2=208.173,11.866,P =0.001）,while stone-free rates decreased（χMH^2=20.553,P =0.000）.Conclusion PCNL can be safely used in any ages.The operational details would be modified with the growth of kidney.The smaller the age,the more advantage.Especially patients under three years old would benefit most from this technique.