影响PCNL术后残留结石二期手术治疗方式选择的相关因素分析

发布时间：2018-06-27 03:51

本文选题：经皮肾镜取石术 + 残留结石　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:一期PCNL术后残留结石二期治疗方案选择的问题仍是泌尿外科医师需要面对的难题,而残留结石二期治疗方案的选择没有一个统一的标准。本文目的在于寻找一期行经皮肾镜取石术(PCNL)后,影响残留结石二期手术治疗方式选择的相关因素,为泌尿外科医师在选择治疗方案时提供一个参考。方法:回顾性收集上海长海医院泌尿外科2015年5月-2016年8月间接受PCNL术后二期残留结石手术治疗的患者的临床资料,包括年龄、性别、糖尿病、高血压、残留结石负荷、手术时间、是否有感染、是否解剖畸形、影像学表现及治疗费用、术前肌酐、术后肌酐、术前血红蛋白、术后血红蛋白等,计数资料采用方差分析,计量资料采用卡方检验,进行统计学分析。结果:共纳入226例患者,其中126例行二期PCNL,93例行F-URL,9例行PCNL联合F-URL碎石术。单因素分析结果显示,术前结石负荷、结石清除率、术中出血量、肾脏解剖畸形、手术时间、治疗费用(P0.05)对二期残留结石手术治疗方案的选择具有统计学意义,而年龄、性别、高血压、糖尿病、肌酐变化情况、有无尿路感染对手术方式选择的影响没有统计学意义。多因素Logistic回顾分析显示,结石负荷[OR=2.103,95%CI(3.520-6.871)]、结石清除率[OR=2.058,95%CI(1.024-3.265)]、肾脏解剖畸形[OR=1.627,95%CI(1.478-5.521)]是影响残留结石二期手术方案选择的独立因素,此外,在血红蛋白变化值,手术时间,手术费用等方面在三组之间无明显统计差异。结论:残留结石负荷、二期结石的清除率、术中出血量、肾脏解剖畸形、手术时间及治疗费用是PCNL术后二期手术治疗方案选择的影响因素。残留结石负荷、结石清除率、有无解剖畸形是二期手术方式选择的独立影响因素。二期PCNL适用于残留结石负荷较大的患者,具有较高的结石清除率,但是增加了肾脏损伤及出血的风险;F-URL适合于处理残留结石负荷较小的患者,具有安全性高,术中损伤小,结石清除率较高的特点,是值得推广的;二期PCNL联合F-URL具有安全,高效,而且并发症相对较少的优点,虽然费用较高,但是对于肾脏解剖复杂的结石残留患者,可以提高结石清除率。泌尿外科医生在选择残留结石二期手术治疗方式的时候应综合考虑患者的情况,选择合适的手术方式。
[Abstract]:Objective: the choice of two stage treatment options for residual stones after PCNL is still a difficult problem in Department of Urology, and there is no unified standard for the choice of the two phase of residual stones. The purpose of this study is to find a stage of percutaneous nephrolithotomy (PCNL) and to affect the choice of the two stages of surgical treatment for residual stones. The relevant factors provide a reference for Department of Urology doctors to choose the treatment plan. Methods: retrospective collection of clinical data of patients undergoing two stages of residual calculi after PCNL operation in Changhai Hospital of Shanghai, May 2015 -2016 year, including age, sex, diabetes, hypertension, residual stone load, operation time, Whether there were infection, dissection of malformation, imaging performance and treatment costs, preoperative creatinine, postoperative creatinine, preoperative hemoglobin, hemoglobin, and postoperative hemoglobin, counting data were analyzed by variance analysis, chi square test was used for statistical analysis. Results: 226 cases were included in 126 cases of two PCNL, 93 cases of F-URL, and 9 cases of PCNL. Combined F-URL lithotripsy. Single factor analysis showed that preoperative lithiasis load, stone clearance, intraoperative bleeding, renal anatomical malformation, operation time, and treatment cost (P0.05) were statistically significant for the selection of surgical treatment for two phase residual stones, while age, sex, hypertension, diabetes, creatinine, and no urinary tract infection The effects of surgical options were not statistically significant. Multiple factor Logistic retrospective analysis showed that stone load [OR=2.103,95%CI (3.520-6.871)], stone clearance rate [OR=2.058,95%CI (1.024-3.265)], renal anatomical malformed [OR=1.627,95%CI (1.478-5.521)] was an independent factor affecting the selection of the two phase of the residual stone operation, in addition to blood red eggs There was no significant statistical difference between the three groups. Conclusion: residual calculi load, two stage stone clearance, intraoperative bleeding, renal anatomical malformation, operation time and treatment cost are the factors influencing the selection of two stages of surgical treatment after PCNL. Residual stone load, stone clearance rate, or not Anatomic malformation is an independent factor in the choice of two stages of operation. The two phase of PCNL is suitable for patients with large residual stone load, with higher stone clearance, but increased risk of renal injury and bleeding; F-URL is suitable for patients with smaller residual stone load, with high safety, small intraoperative damage and stone clearance rate. The high characteristics are worthy of promotion; the two phase PCNL combined with F-URL has the advantages of safety, high efficiency and relatively less complications. Although the cost is high, the stone clearance rate can be improved for the patients with complicated renal anatomy and residual stones. The urologist should take into consideration the comprehensive consideration when choosing the two stage of surgical treatment for the residual stone. In the case of the person, choose the appropriate surgical method.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699

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