B超引导下微创经皮肾镜取石术治疗肾结石的疗效及出血因素分析

目的 分析B超协助引导下微创经皮肾镜取石术（MPCNL）治疗肾结石的临床疗效以及出血并发症的诱发因素。方法 选择2013年7月~2016年6月于笔者医院住院治疗的160例肾结石患者，随机分为对照组（开放手术取石）和观察组（B超引导下经皮肾镜取石），各80例；记录并比较两组患者手术时间、出血量、并发症发生率、住院时间、结石清除率，采用Logistic多因素回归分析法研究出血影响因素。结果 与对照组比较，观察组患者手术时间显著缩短（0.98±0.13 vs 2.16±0.80h）、出血量显著降低（120.6±37.5 vs 591.7±102.4ml）：并发症发生率显著降低2.5%（2/80） vs 17.5%（14/80）]、平均住院时间显著缩短（9.5±2.1 vs 21.7±3.4天），差异均有统计学意义（P<0.05）；两组患者结石清除率比较，差异无统计学意义（P>0.05）。Logistic多因素回归分析结果显示，MPCNL治疗肾结石出血与手术时间、结石类型、糖尿病、肾功能不全及泌尿系感染等因素密切相关。结论 B超引导下MPCNL治疗肾结石疗效确切且具有手术时间短、并发症发生率低、出血量少等优势。为进一步降低出血风险，应关注糖尿病、肾功能、结石类型以及泌尿系感染等因素。

Clinical Efficacy of Minimally Invasive Percutaneous Nephrolithotomy on Kidney Stones and Analysis of Bleeding Factors

Objective To analysis the clinical efficacy of minimally invasive percutaneous nephrolithotomy on kidney stones and the predisposing factors of bleeding. Methods We selected 160 patients with kidney stones treated in our hospital from July 2013 to June 2016, who were randomly divided into control group(open surgical treatment) and observation group(B-ultrasound guided percutaneous nephrolithotomy)(n=80). The operation time, amount of bleeding, complication rate, length of hospitalization, stone clearance rate of the two groups were recorded and compared; the influencing factors of bleeding were analyzed by logistic multivariate regression analysis. Results Compared with control group, the operation time of observation group was significantly shortened (0.98±0.13 vs 2.16±0.80h), the amount of bleeding was significantly decreased(120.6±37.5 vs 591.7±102.4ml), the complication rate was significantly decreased2.5%(2/80) vs 17.5%(14/80)], the length of hospitalization was significantly shortened (9.5±2.1 vs 21.7±3.4d), all of the differences above was significant(P<0.05). While, there was no significant difference in stone clearance rate between the two groups (P>0.05). Multivariate Logistic regression analysis showed that the operation time, stone type, diabetes, renal insufficiency, urinary tract infection was closely related to bleeding in MPCNL treatment of renal calculus. Conclusion B-ultrasound guided MPCNL in the treatment of renal calculi is effective and which has the sdvantage of shorter operation time, lower incidence of complications and less bleeding. To further reduce the risk of intraoperative bleeding, we should be concerned about diabetes, renal function, type of stones and urinary tract infections and other factors.