不同肾盂漏斗部夹角肾下盏结石病人采用不同术式的疗效及疗效相关因素分析

Analysis of curative effect and curative effect-related factors of different surgical procedures for patients with inferior calyx calculi with different funnel angles of the renal pelvis

目的探讨不同肾盂漏斗部夹角(IPA)肾下盏结石病人采用不同术式的疗效及疗效相关因素。方法2019年6月~2020年6月我院泌尿外科收治的肾下盏结石病人198例,根据IPA角度分为两组,A组IPA>30°,B组IPA≤30°。再根据各组手术方式分为4个亚组,A1组70例,采用微通道经皮肾镜碎石术(MPCNL),A2组62例,采用输尿管软镜钬激光碎石术(FURS),B1组23例,采用FURS术,B2组43例,采用FURS联合MPCNL术。比较各组临床疗效、并发症发生情况,并分析肾下盏结石疗效的影响因素。结果A1组和A2组手术时间、术后住院时间、结石清除率、并发症发生率比较,差异均无统计学意义(P>0.05);B1组和B2组手术时间、术后住院时间、并发症发生率比较,差异无统计学意义(P>0.05),但B2组结石清除率高于B1组,差异有统计学意义(P<0.05)。198例病人中结石清除完全者167例(清除组),清除不完全者31例(未清除组)。清除组体质量指数(BMI)<25 kg/m^(2)者高于未清除组,清除组IPA大于未清除组,肾盂漏斗部长度(IL)、结石直径小于未清除组,差异均有统计学意义(P<0.05)。多因素Logistic回归显示,BMI高、IPA小、IL长、结石直径大是导致肾下盏结石术后疗效不佳的独立危险因素(P<0.05)。结论IPA>30°的肾下盏结石,采用MPCNL和FURS的结石清除效果差别不大,但IPA≤30°的肾下盏结石,FURS结石清除效果有限,与MPCNL联合应用能获得更好的治疗效果;BMI高、IPA小、IL长、结石直径大是导致肾下盏结石术后疗效不佳的独立危险因素。

Objective To explore the curative effect of different surgical methods and analysis of curative effect-related factors in patients with inferior calyx stones with different infundibulum angles of the renal pelvis.Methods A retrospective analysis of the case data of 198 patients with inferior calyx stones admitted to the Department of Urology in our hospital from June 2019 to June 2020 was divided into two groups according to the IPA angle.Group A IPA>30°,Group B IPA≤30°group,divided into 4 subgroups according to the operation method of each group,A1 group(70 cases)was treated with microchannel percutaneous nephrolithotomy(MPCNL),and A2 group(62 cases)was treated with ureteroscopy holmium laser Lithotripsy(FURS)was used for treatment.Group B1(23 cases)was treated with FURS,and group B2(43 cases)was treated with FURS combined with MPCNL.The curative effect and complications of each group were compared,and the factors affecting the curative effect of lower calyx stones were analyzed.Results There was no statistically significant difference in operation time,postoperative hospital stay,stone removal rate,and complication rate between group A1 and group A2(P>0.05);group B1 and group B2 had no significant difference in operation time,postoperative hospital stay,There was no statistically significant difference in the incidence of complications(P>0.05),but the stone clearance rate in group B2 was higher than that in group B1,and the difference was statistically significant(P<0.05).Among the 198 patients,167 had complete stone removal(the removal group),and 31 cases had incomplete stone removal(uncleared group).The body mass index(BMI)<25 kg/m^(2) of the cleared group was higher than that of the uncleared group,the angle of the renal pelvic funnel(IPA)was higher in the cleared group,and the length of the renal pelvic funnel(IL)and stone diameter were lower than those of the uncleared group.The differences were statistically significant(P<0.05).Multivariate logistic regression showed that high BMI,small IPA,long IL,and large calculus diameter were independent risk factors that led to poor postoperative efficacy of inferior calyx stones(P<0.05).Conclusion In the renal calculus with IPA>30°,MPCNL and FURS have little difference in stone removal effect,but with IPA≤30°,the FURS calculus removal effect is limited,and the combined application with MPCNL can obtain better treatment effect;Moreover,high BMI,small IPA,long IL,and large calculus diameter are independent risk factors that lead to poor postoperative efficacy of inferior calyx stones.