超声引导下经皮肾镜治疗上尿路结石和结石残留因素分析

Ultrasound-guided percutaneous nephrolithotomy for the treatment of upper urinary calculi and analysis of residual factors of stones

目的分析超声引导下标准通道经皮肾镜治疗上尿路结石疗效和结石残留因素。方法回顾性分析2016年1月至2017年6月间在我院泌尿外科采用标准通道PCNL治疗的上尿路结石43例患者的资料,比较经标准通道PCNL治疗各类上尿路结石的疗效,比较不同类型结石术后的清石率;根据术后5～7d复查腹部平片及B超的结果,将研究对象分为结石残留组和非结石残留组,分析经标准通道PCNL治疗后影响清石率术前因素和术中因素。结果不同类型5种的上尿路结石在术中出血量、术后结石残留率两方面的差异有统计学意义(P<0.05),在B超定位穿刺时间、建立通道时间、处理结石时间、拔出肾造瘘管时间以及术后住院天数上不同类型结石的差异均无统计学意义(P>0.05);结石类型、结石直径、结石位置、肾积水严重程度等术前因素与术后结石残留具有相关性(P<0.05),性别、年龄差异无统计学意义(P>0.05)。术中通道数量、B超定位穿刺时间、处理结石时间及术中出血量这些术中因素与术后结石残留具有相关性(P<0.05),本组研究中穿刺位置与建立通道时间在结石残留组和无结石残留组的差异中无统计学意义(P>0.05)。结论经标准通道PCNL是安全有效的;结石类型、结石大小、结石位置、肾积水程度、术中通道数量、B超定位穿刺时间、处理结石时间、术中出血量均是影响结石残留的因素。

Objective The effects of ultrasound-guided percutaneous nephrolithotomy on upper urinary calculi and residual stones were analyzed.Methods Retrospective analysis of 43 patients with upper urinary calculi treated with standard channel sPCNL in our department of urology from January 2016 to June 2018 were performed.The efficacy of standard channel sPCNL and the rate of clear stone after stone surgery in the treatment of various upper urinary calculi were analyzed;According to the results of abdominal plain film and B-ultrasound after 5-7 days postoperatively,the study subjects were divided into stone residual group and non-calculus residual group,and the rate of clear stone after treatment with standard channel sPCNL,the preoperative factors and intraoperative factors were analyzed.Results There were significant differences in the amount of intraoperative blood loss and residual stone residual rate between the 5 types of upper urinary tract stones of different types(P<0.05).The time of P-positioning was established,the channel time was established,the stone time was treated,and the stone was removed.There were no significant differences in the different types of stones between the time of renal fistula and postoperative hospital stay(P >0.05);There was a correlation between preoperative factors and postoperative residual stones,such as stone type,stone diameter,stone position,severity of hydronephrosis,preoperative urinary tract infection,etc.(P<0.05).There was no significant difference in gender and age(P >0.05).The intraoperative factors such as the number of intraoperative channels,B-positioning puncture time,stone treatment time and intraoperative blood loss were correlated with postoperative calculus residuals(P<0.05).In this study,the puncture site and the established channel time were in the stone.There was no significant difference between the residual group and the no-residue group(P >0.05).Conclusions Standard access percutaneous nephrolithotomy was safe and effective through standard channel;stone type,stone size,stone position,degree of hydronephrosis,number of intraoperative channels,B-positioning puncture time,stone treatment time,intraoperative blood loss were all factors affecting stone residue.