经皮肾镜碎石取石术治疗孤立肾结石的临床分析

目的 探讨经皮肾镜碎石取石术治疗孤立肾结石的临床疗效及分析手术并发症的危险因素.方法 回顾性分析本院2009年11月至2016年1月行经皮肾镜碎石取石术治疗的孤立肾结石患者,记录患者的一般资料、术中及术后情况,记录术前术后血红蛋白、血肌酐并进行比较;Logistic回归分析评估出血及手术并发症的相关危险因素.结果 本组32例,男性9例,女性23例,平均年龄47.75(29 ～ 67)岁,平均BMI 23.7(18.2 ～ 28.4) kg/m2,鹿角形结石1例,多发结石11例,平均结石含量501.25(300 ～ 800) mm2,Guys结石分级:1级11例(34.4％)、2级9例(28.1％)、3级11例(34.4％)、4级1例(3.1％).4例患者建立两个经皮肾通道;平均手术时间73.75(40 ～ 120) min,平均术中估计出血量85 (40～300)mL,26例患者结石完全清除,总的结石清除率81.25％.3例患者发生手术并发症.手术前后血红蛋白、血肌酐均未发生明显变化.Logistic回归分析提示多个经皮肾通道的建立增加出血风险,手术时间延长增加手术并发症的发生.结论 经皮肾镜碎石术治疗孤立肾结石排石率高、手术并发症少.多个经皮肾通道的建立增加手术出血风险.

Clinical analysis of percutaneous nephrostomy in the treatment of solitary kidney calculi

Objective To investigate the clinical efficacy of percutaneous nephrolithotomy (PCNL) for renal calculi in solitary kidneys and analyze risk factors of operative complications.Methods The clinical data of 32 patients with reual calculi in solitary kidneys in our hospital were recorded and retrospectively analyzed from November 2009 to January 2016.Logistic regression was used to analyze the risk factors of bleeding and operative complications.Results Thirty-two patients were enrolled in our study,including 9 males and 23 females,the mean age was 47.75 (29 ～ 67) years old,mean BMI was 23.7(18.2～28.4) kg/m2,one staghorn calculi,11 multiple stones,mean stone burden was 501.25(300800) mm2,the Guys score:11 cases of Guys 1,9 cases of Guys 2,11 cases of Guys 3,1 case of Guys 4.Four patients were established two tracts,the mean operative time was 73.75 (40～120) min,the mean blood loss of the operation was 85 (40 ～300) mL,stone free rate was 81.25％.Three patients had operative complications.There was no significant variation in HIb and SCr before and after operation.Logistic regression confirmed number of access tracts as significantly related to bleeding while operative time related to surgical complications.Conclusions PCNL for renal calculi in solitary kidneys has high stone free rate with a low operative complication rate.Multiple access tracts are associated with increased bleeding.