目的 通过分析有症状和无症状尿路结石病例之间的临床资料、手术疗效及肾功能变化的差异,来了解无症状尿石症的临床特征. 方法 回顾性分析2008—2013年87例有症状的尿石症病例和79例无症状尿石症病例的围手术期情况,以及随访1年的肾功能相关变化指标. 比较两组病例的一般特点、手术疗效、安全性和术后肾功能变化. 采用多因素logistic回归分析术后肾功能下降的相关危险因素. 结果 两组手术方式、血红蛋白下降值、术前估算的肾小球滤过率( eGFR)、碎石后eGFR、单次清石率、分次清石率、术后并发症Clavien分级比较差异无统计学意义(P>0. 05);两组手术时间、术后住院时间、随访1年eGFR、肾功能损害比例比较差异具有统计学意义(P<0. 05, P<0. 01). logistic多因素分析结果显示结石大小、糖尿病、碎石术后eGFR为有症状结石组术后肾功能损害的独立危险因素;年龄、肾积水、糖尿病为无症状结石组术后肾功能损害的独立危险因素. 结论 无症状结石患者肾功能损伤可能更严重,应加强管理,定期监测肾功变化,特别是对老年人,及合并糖尿病或肾积水患者尤为重要.%Objective To analyze the differences of clinical data, surgical effectiveness and renal functional changes between symptomatic and asymptomatic urolithiasis patients treated with surgical procedures in order to study the clinical characteristics of asymptomatic urolithiasis patients. Methods Perioperative conditions of 87 symptomatic uroli-thiasis patients and 79 asymptomatic urolithiasis patients from 2008 to 2013 were retrospectively analyzed, and correlative changes of renal function indexes in all patients were followed up for 1 year. The general characteristics, surgical effec-tiveness, safety and postoperative renal functional changes in the two groups were compared. A multiple factor logistic re-gression was performed to confirm the correlative risk factors of postoperative renal functional decline. Results There were no statistical differences in operative methods, decreased value of hemoglobin, preoperative estimated glomerular fil-tration rate ( eGFR) , postoperative eGFR, initial clearance rate, final clearance rate, incidence rate of postoperative complications and Clavien classification of between the two groups ( P>0. 05 ) , and there were statistical differences in operative time, postoperative hospitalization, postoperative eGFR of follow-up for 1 year and damage ratio of renal func-tion in the two groups (P<0. 05, P<0. 01). The multivariate Logistic regression analysis showed that the independent risk factors of renal function damage were stone size, diabetes and postoperative eGFR in symptomatic group, and age, hydronephrosis and diabetes in asymptomatic group. Conclusion Damage of renal function in asymptomatic urolithiasis patients may be more invasive, so clinicians should enhance management and regular monitoring for asymptomatic urolith-iasis patients, especially for elderly, diabetic or preoperatively hydronephrosis patients.
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