钬激光经皮肾镜碎石术治疗维吾尔族与汉族儿童上尿路结石的疗效比较

Efficacy comparison of percutaneous nephrolithotomy with Holmium laser for upper urinary calculi in Uyghur and Han pediatric patients

目的比较钬激光经皮肾镜碎石术(PCNL)治疗维吾尔族儿童与汉族儿童上尿路结石的有效性、安全性以及术后复发情况。方法回顾性分析2018年8月至2023年8月新疆喀什地区第一人民医院收治的123例维吾尔族上尿路结石患儿和首都医科大学附属北京友谊医院收治的71例汉族上尿路结石患儿的临床资料。维吾尔族与汉族患儿的性别[男:73例(59.3%)与46例(64.8%)]、结石侧别[单侧/双侧:94/29例与59/12例]、肾积水[115例(93.5%)与63(88.7%)]、泌尿系结构异常[2例(1.6%)与5例(7.0%)]等差异均无统计学意义(P>0.05)。维吾尔族患儿较汉族患儿年龄大[5(37)岁与3(2,6)岁]、消瘦型比例高[27例(21.9%)与6例(8.5%)]、结石最大径大[(2.30±0.78)cm与(1.96±1.50)cm]、多发结石比例低[46例(37.4%)与52例(73.2%)],差异均有统计学意义(P<0.05)。所有患儿均接受铁激光PCNL治疗,手术均由同一术者实施。本研究中钬激光PCNL手术采用F12~18的小通道及可视穿刺通道两种入路。比较两组患儿手术情况、结石清除率(SFR)、术后并发症发生率以及结石复发率。采用多因素logistic回归分析SFR、并发症发生率以及复发率的影响因素。结果维吾尔族患儿较汉族患儿的手术时间更长[75.0(58.0,93.0)min与30.0(20.048.8)min]、接受F12~18经皮肾镜手术的比例更高[119例(96.7%)与49例(69.0%)],差异均有统计学意义(P<0.05)。维吾尔族患儿与汉族患儿SFR分别为89.4%(110/123)和88.7%(63/71),术后并发症发生率分别为31.7%(39/123)和26.8%(19/71),差异均无统计学意义(P>0.05);维吾尔族患儿术后结石复发率显著高于汉族患儿28.1%(25/89)和15.6%(10/64),P=0.033]。多因素logistic回归分析结果表明,结石最大径(0R=0.401,95%CI 0.191~0.842,P=0.016)是影响两组患儿PCNL术后SFR的独立危险因素;结石最大径(OR=1.896,95%CI1.088~3.304,P=0.024)和结石多发(0R=3.225,95%CI 1.409~7.384,P=0.024)是影响两组患儿PCNL术后并发症发生率的独立危险因素。民族不是SFR(OR=0.679,95%CI 0.215~2.140)、并发症发生率(OR=1.047,95%CI0.495~2.215)和结石复发率(0R=0.820,95%CI0.285~2.356)的独立影响因素(均P>0.05)。结论与同时期同一术者治疗的汉族患儿相比,钬激光PCNL可在治疗年龄更大、更加消瘦以及结石最大径更大的维吾尔族患儿中获得相似的结石清除率和并发症发生率;维吾尔族患儿较高的复发率可能与该人群较大的结石负荷相关。多因素分析结果显示,民族不是SFR、并发症发生率和结石复发率的影响因素。研究结论尚需更大规模的前瞻性队列研究进一步验证。

Objective To compare the effectiveness,safety and postoperative recurrence of percutaneous nephrolithotomy(PCNL)with Holmium laser for upper urinary calculi in Uyghur and Han pediatric patients.Methods The data of 123 Uyghur and 71 Han pediatric patients with upper urinary calculi admitted to First People's Hospital of Kashgar,Xinjiang and Beijing Friendship Hospital,Capital Medical University respectively,from August 2018 to August 2023,were retrospectively reviewed.The gender[males 73(59.3%)vs.46(64.8%)],laterality(single/bilateral:94/29 vs.59/12),hydronephrosis[115(93.5%)vs.63(88.7%)]and anatomical abnormalities[2(1.6%)vs.5(7.0%)]of Uyghur and Han children were not statistically significant(P>0.05).Uyghur children were older than Han children[5(3,7)vs.3(2,6)years old],with a higher proportion of emaciated children[27(21.9%)vs.6(8.5%)cases],a larger maximum stone diameter[(2.30±0.78)vs.(1.96±1.50)cm]and a lower proportion of multiple stones[46(37.4%)vs.52(73.2%)cases](all P<0.05).All the patients were treated with Holmium laser PCNL.The channels of the procedures in this study include F12-18 small channels and visual puncture channels.The operation datas,stone-free rate(SFR),complication rate(CR)and stone recurrence rate of the two groups were compared.Meanwhile,multiple logistic regression analysis was used to explore the factors influencing these indicators.Results The operation time for Uyghur children was significantly longer than that of Han children[75.0(58.0,93.0)vs.30.0(20.0,48.8)minJ.Additionally,a greater proportion of Uyghur children underwent PCNL with F12-18 small channels than Han children[119(96.7%)vs.49(69.0%)cases].The SFR[89.4%(110/123)vs.88.7%(63/71)],and postoperative CR[31.7%(39/123)vs.26.8%(19/71)]in Uyghur and Han patients were not significantly different(all P>0.05).The recurrence rate in Uyghur children was higher than that observed in Han children[28.1%(25/89)vs.15.6%(10/64),P=0.033].The multivariate logistic regression analysis results indicated that the maximum stone diameter was an independent risk factor for SFR in both groups(0R=0.401,95%CI 0.191-0.842,P=0.016).Similarly,maximum stone diameter(OR=1.896,95%CI 1.088-3.304,P=0.024)and multiple stones(OR=3.225,95%CI 1.409-7.384,P=0.024)were identified as independent risk factors for CR.Ethnicity was not independent risk factor for SFR(0R=0.679,95%CI 0.215-2.140),CR(OR=1.047,95%CI 0.495-2.215)and stone recurrence rate(OR=0.820,95%CI 0.285-2.356,all P>0.05).Conclusions In comparison to Han pediatric patients during the same period,Holmium laser PCNL had similar SFR and CR for treating Uyghur children with upper urinary calculi,who were older,more emaciated and had larger average stone diameters.The higher postoperative recurrence rate of Uyghur children is likely to be associated with higher stone burden.The multivariate logistic regression analysis results showed that ethnicity was not an influential factor in SFR,complication rates,and stone recurrence rates.The findings need to be further validated in larger prospective cohort studies.