影响经皮肾镜碎石术治疗鹿角型肾结石清石率及并发症的因素分析

摘要

Objective To determine elements in fluencing the stone-free rate and complications of percutaneous nephrolithotomy(PNL)for therapy of staghorn stones. Methods The computerized database of patients who underwent PNL for therapy of staghorn stones betweenJanuary 2010 and January 2014 was reviewed. All perioperative complica-tions were recorded. The stone-free rate was evaluated with low-dose noncontrast computed tomography (CT). Un-ivariate and multivariate statistical analyses were performed to determine elementsinfluencing stone-free and compli-cation rates. Resluts The study included 82 patients (42 male and 40 female)with a mean age of 46. 5 ± 13. 9 years. All patients underwent 92 PNL (10 patients had bilateral stones). The stone-free rate of PNL monotherapy was 53%(49 procedures). At 3 months,the stone-free rate increased to 75%(69 kidneys)after shock wave lithotripsy. In-dependent risk elements for residual stones were complete staghorn stone and presence of secondary calyceal stones (relative risks were 2. 1 and 3. 2,respectively). The complication rate was 25%(23 PNL). Independent risk ele-ments for development of complications were performance of the procedure by urologists other than experienced endou-rologist and positive preoperative urine culture (relative risks were 2. 3 and 2. 4,respectively). Conclusions Elements influencing the incidence of residual stones after PNL are complete staghorn stones and the presence of secondary ca-lyceal stones. Complications are significantly high if PNL is not performed by an experienced endourologist or if pre-operative urine culture is positive.%目的：分析经皮肾镜碎石术（percutaneous nephrolithotomy，PNL）治疗鹿角型肾结石时，影响清石率及并发症的因素。方法收集2010年1月至2014年1月因鹿角型肾结石于本院泌尿微创中心行经皮肾镜碎石术的患者资料。记录所有围手术期并发症。清石率的评估采用低照射量的平扫CT，并通过单变量及多变量统计分析影响清石率及并发症的因素。结果本研究收纳了82位鹿角型结石患者（42位男性和40位女性），平均年龄（46．5±13．9）岁，所有患者共行92次一期PNL（其中10位患者为双侧鹿角型结石）。一期PNL治疗鹿角型肾结石的清石率为53％（49次PNL）。另行体外冲击波碎石术（shock wave lithotripsy，SWL），术后3个月时清石率增加至75％（69例肾脏）。影响残留结石的独立危险因素包括完整的鹿角型结石以及合并肾盏结石（相对危险度分别为2．1和3．2）。并发症发生率为25％（23例PNL）。出现并发症的独立危险因素包括手术医师的经验以及术前尿培养结果（相对危险度分别为2．3和2．4）。结论 PNL术后出现残留结石的影响因素包括完整的鹿角型结石及合并肾盏结石。术前尿培养结果为阳性，或者手术操作者经验匮乏，都会增加术后并发症的发生率。