输尿管软镜术后肾结石患者的临床特征及结石残留的影响因素分析

Analysis of Clinical Features of Patients with Renal Calculi after Ureteroscopy and Influencing Factors of Residual Calculi

目的:探究输尿管软镜术后肾结石患者的临床特征及结石残留的影响因素。方法:选择2019年1月~2022年1月本院收治的200例肾结石患者,所有患者予以输尿管软镜术治疗,术后一周,开展泌尿系CT及尿路平片复查,根据术后结石残留情况,将其分为无残石组(n=155)及残石组(n=45)。并依据两组患者术后是否伴随并发症,将其分为并发症组(n=41)及无并发症组(n=159)。比较术后并发症组与无并发症组的基线资料、术后结石残留率、影响肾结石患者术后结石残留的单因素及肾结石患者术后结石残留的Logistic回归分析。结果:既往输尿管疾病史、鹿角形结石、操作时间及住院时间,均会在不同程度上增加术后并发症风险(P<0.05),年龄、术前合并慢性病、性别、体质量指数、结石位置未明显增加术后并发症风险(P>0.05);200例肾结石患者,输尿管软镜术后,结石残留率为22.50%(45/200),结石清除率为77.50%(155/200),残石组及无残石组性别、年龄及平均病程比较,无较大差异(P>0.05);肾功能不全、结石直径、结石数量、结石脓苔包裹、肾盂肾下盏夹角、结石成分、手术时间、术中出血量是影响肾结石术后结石残留的单因素(P<0.05),糖尿病、高血压、肾积水、结石位置等因素未对术后结石残留产生显著影响(P>0.05);Logistic回归分析提示,肾功能不全、结石直径≥2 cm、结石脓苔包裹、肾盂肾下盏夹角<30°及结石成分是影响肾结石患者术后结石残留的独立危险因素(P<0.05)。结论:肾结石患者输尿管软镜术后,可依据影响术后并发症的临床特征,对不良风险事件予以预警,此外研究结果提示,肾功能不全、结石直径≥2 cm、结石脓苔包裹、肾盂肾下盏夹角<30°及结石成分是影响结石残留的独立危险因素,术前可基于危险因素开展相应预防,以提高结石清除率。

Objective:To explore the clinical characteristics of patients with kidney stones after ureteroscopy and the influencing factors of stone residue.Methods:200 patients with kidney stones admitted to our hospital from January 2019 to January 2022 were selected.All patients were treated with ureteroscopy.One week after surgery,urinary CT and ureterographic reexamination were carried out.According to the residual postoperative stones,they were divided into no stone group(n=155)and residual stone group(n=45).According to the two groups,they were divided into complications(n=41)and no complications(n=159).Baseline data,postoperative stone residue rate,single factors affecting postoperative stone residue in patients with kidney stones and Logistic regression analysis of postoperative stone residue in patients with kidney stones were compared between the postoperative complication group and the non-complication group.Results:Baseline data analysis results of postoperative complication group and non-complication group showed that previous history of ureteral disease,antler calculus,operation time and hospital stay all increased the risk of postoperative complications to varying degrees(P<0.05).Age,preoperative chronic disease,gender,body mass index and stone location did not significantly increase the risk of postoperative complications(P>0.05);In 200 patients with kidney stones after ureteroscopy,the stone residual rate was 22.50%(45/200)and stone clearance rate was 77.50%(155/200).There were no significant differences in gender,age and average course of disease between the residual stone group and the non-residual stone group(P>0.05);Renal insufficiency,stone diameter,stone number,stone pus coating,renal lamp,stone composition,operation time,intraoperative bleeding is the postoperative stone residue(P<0.05),diabetes,hypertension,hydronephrosis,stone location did not have a significant impact on postoperative stone residue(P>0.05).Logistic Regression analysis suggested that renal insufficiency,stone diameter of 2cm,stone pus coating,renal calycapus Angle<30 and stone composition were independent risk factors for postoperative stone remains in patients with kidney stones(P<0.05).Conclusion:After ureteroscopy,adverse risk events in patients with renal calculi can be warned according to clinical characteristics affecting postoperative complications.In addition,the study results suggest that renal insufficiency,stone diameter≥2 cm,stone abscess coating,Angle between pelvis and renal calyx<30°and stone composition are independent risk factors affecting stone residue,and preoperative prevention can be carried out based on risk factors.To improve the stone clearance rate.