孤立肾结石患者经皮肾镜术后肾功能转归的影响因素研究

发布时间：2018-07-29 15:36

【摘要】：目的：研究影响孤立肾并泌尿系结石患者接受mPCNL术后肾功能变化的因素,为临床治疗提供参考。方法：自2012年3月至2013年5月,收集了中南大学湘雅医院泌尿外科采用mPCNL治疗并且符合入选标准的73例孤立肾并泌尿系结石患者的资料进行研究。根据患者术后1年肾功能情况将患者分为肾功能恶化组：术后1年GFR较术前下降超过5%；肾功能稳定或好转组：术后1年GFR较术前下降不到5%或高于术前。观察指标包括人口学资料(年龄、性别、BMI),是否有上尿路手术史,是否合并糖尿病、高血压、蛋白尿,结石表面积,术前肾皮质厚度,术前肾功能,术前尿常规及尿培养情况,手术时间,术中出血量等。先使用t检验或x2检验进行单变量分析,再使用二元logistic回归筛选出此类患者术后肾功能恶化的危险因素及保护因素,从而对影响孤立肾结石患者mPCNL术后肾功能变化情况进行探讨。结果：本实验73例患者中47例术后肾功能稳定或好转,26例术后肾功能恶化,全部73名患者术后1月复查KUB,62名患者结石完全取净,结石清除率为84.9%。经单变量分析及二元logistic回归分析,术前肾皮质厚度是术后肾功能情况的保护因素(B=-1.233,OR=0.292),而蛋白尿(B=1.607,OR=4.990)、尿路感染(B=1.751,OR=5.763)以及高血压(B=1.262,OR=3.533)是术后肾功能情况的危险因素。结论：孤立肾并泌尿系结石患者行PCNL术后肾功能的转归与多种因素有关。术前肾皮质厚度较厚的患者术后肾功能维持稳定或好转的可能性较大,反之术前肾皮质厚度较薄的患者术后肾功能恶化的可能性较大；而术前尿蛋白阳性、有尿路感染、合并高血压病的患者术后肾功能较术前变差的可能性较大,反之无这些合并疾病的患者术后肾功能好转或维持稳定的可能性较大。
[Abstract]:Objective: to study the influencing factors of renal function after mPCNL in patients with solitary kidney and urinary calculi, and to provide reference for clinical treatment. Methods: from March 2012 to May 2013, 73 patients with solitary kidney and urinary calculi who were treated with mPCNL in Xiangya Hospital of Central South University were studied. According to the condition of renal function in one year after operation, the patients were divided into two groups: one year after operation, the GFR decreased by more than 5% than that before operation, and in the group of stable or improved renal function, the GFR decreased less than 5% or higher than that before operation at 1 year after operation. The data included demographic data (age, sex and BMI), history of upper urinary tract surgery, diabetes mellitus, hypertension, proteinuria, stone surface area, preoperative renal cortex thickness, preoperative renal function, preoperative urine routine and urine culture. Operative time, intraoperative bleeding, etc. T test or x2 test was used for univariate analysis, then binary logistic regression was used to screen out the risk factors and protective factors of renal function deterioration after operation. The changes of renal function after mPCNL in patients with solitary renal calculi were discussed. Results: in this study, 47 cases of renal function were stable or improved after operation, 26 cases of renal function deteriorated after operation. All 73 cases of KUBU 62 patients were completely removed stones, the stone clearance rate was 84.9%. By univariate analysis and binary logistic regression analysis, renal cortex thickness before operation was the protective factor of renal function after operation (BH-1. 233 OR0.292), while proteinuria (B1. 607), urinary tract infection (B1. 751) and hypertension (B1. 262 OR3. 533) were risk factors of renal function after operation. Conclusion: the prognosis of renal function after PCNL in patients with solitary kidney and urinary calculi is related to many factors. The patients with thicker thickness of renal cortex were more likely to maintain stable or improve renal function after operation, whereas patients with thinner thickness of renal cortex before operation were more likely to deteriorate renal function after operation, while patients with positive urinary protein before operation had urinary tract infection, while patients with thicker thickness of renal cortex before operation were more likely to deteriorate renal function after operation. The possibility of renal function deterioration after operation in patients with hypertension was higher than that in patients without hypertension, whereas the possibility of improving or maintaining stability of renal function in patients without these diseases was higher.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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