经皮肾镜取石术对不同肾窦分离程度肾结石患者的治疗效果分析

Effect analysis of percutaneous nephrolithotomy in the treatment of kidney stones with different degrees of renal sinus separation

目的:探讨经皮肾镜取石术(PCNL)对不同肾窦分离程度肾结石患者的治疗效果,分析其并发症发生的影响因素。方法:回顾性分析2019年1月至2021年12月在联勤保障部队第九〇九医院收治的167例肾结石患者的临床资料,患者均行PCNL治疗。根据术前彩超判断肾窦分离情况将患者分为A组(53例)、B组(63例)和C组(51例),分析三组患者的手术时间、术中失血量、术后第1天血红蛋白下降值、住院时间和并发症发生率,并采用单因素和logistic多因素分析术后并发症发生的影响因素。结果:A组患者的手术时间、术中失血量和术后第1天血红蛋白下降值多于B组和C组,而B组患者的术中失血量高于C组(均P<0.05)。A组患者的严重血尿和包膜下血肿发生率高于B组和C组,差异均有统计学意义(均P<0.05)。多因素logistic分析结果显示,体质量指数(BMI)、结石最大径、手术时间、术中失血量和肾窦分离是PCNL术后并发症发生的独立影响因素(均P<0.05)。结论:肾窦分离程度较小的肾结石患者的PCNL术后出血发生率较高,同时BMI、结石大小、手术时间、术中失血量、肾窦分离程度是PCNL术后并发症发生的独立影响因素,对临床具有一定指导意义。

Objective To investigate the effect of percutaneous nephrolithotomy(PCNL)on the treatment of renal stones with different degrees of renal sinus separation and the influencing factors of complications.Methods The clinical data of 167 patients with kidney stones tract stones admitted to 909th Hospital of the Joint Logistic Support Force from January 2019 to December 2021 were retrospectively analyzed.All patients were treated with PCNL.According to preoperative color ultrasound,the patients were divided into group A(53 cases),group B(63 cases)and group C(51 cases).The operation time,intraoperative blood loss,hemoglobin decline on the first day after surgery,length of hospital stay and incidence of complications in the three groups were analyzed,and the influencing factors of postoperative complications were analyzed by univariate and logistic multivariate factors.Results The operative time,intraoperative blood loss and the decrease of hemoglobin on the first day after surgery in group A were higher than those in group B and group C,while the intraoperative blood loss in group B was higher than that in group C(all P<0.05).The incidence of severe hematuria and subcapsular hematoma in group A was higher than that in group B and group C,and the differences were statistically significant(all P<0.05).Multivariate logistic analysis showed that body mass index(BMI),maximum stone diameter,operation time,intraoperative blood loss and renal sinus separation were independent influencing factors for postoperative complications of PCNL(all P<0.05).Conclusions The incidence of hemorrhage after PCNL is high in patients with renal calculus with small renal sinus separation degree.Meanwhile,BMI,stone size,operation time,intraoperative blood loss and renal sinus separation degree are independent factors influencing the occurrence of postoperative complications of PCNL,which has guiding significance for clinical practice.