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鹿角形肾结石分支数对经皮肾镜取石术的影响

Clinical analysis of percutaneous nephrolithotomy for staghorn calculi with different stone branch number

摘要:

目的 探讨鹿角形肾结石分支数对经皮肾镜取石术(PNL)结果的影响.方法 回顾性分析2009年1月至2013年1月371例患者(386侧)鹿角形肾结石的CT三维重建(3-DR)资料和经皮肾镜取石术结果.纳入标准为结石分支数≥2,排除标准为解剖结构异常(如马蹄肾、异位肾等)肾结石.根据3-DR记录结石的分支数,并按分支数将患肾分为4组:第1组分支数2~4,第2组分支数5~7,第3组分支数8~ 10,第4组分支数>10.对组间皮肾通道数、手术时间、失血量、分期手术、净石率、术后住院天数及并发症进行比较.结果 371例患者(386侧患肾)均成功完成PNL手术.其中单通道手术144侧,多通道242侧.一期手术289侧,分期手术97侧.平均手术时间(100±50) min,平均失血量(83±67)ml,净石率为61.7%(术后3d)、79.5%(术后3个月).术后平均住院时间(6.9±3.4)d.统计结果显示,当结石分支数≥5时,PNL过程中使用多通道的几率增加(x2=212.220,P<0.01),分期手术的几率亦增加(x2=49.679,P<0.01),且手术时间延长(F =4.652,P<0.01),术后住院天数增加(F =2.067,P =0.043),净石率降低(x2=10.691、47.369,P<0.05).使用改进的Clavien分级系统评估并发症无明显差异(P =0.460).结论 鹿角形肾结石分支数≥5时,多通道及分期PNL的可能性增加,净石率下降,住院天数延长.

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Objective To investigate the impact of staghorn stone branch number on outcomes of percutaneous nephrolithotomy (PNL).Methods From January 2009 to January 2013,the 371 patients with staghorn stones who were referred to our hospital for PNL were considered for this study.All calculi were showed with CT 3-dimentional reconstruction (3-DR) imaging.The computerized database of the patients had been reviewed.Our exclusion criterion was patients with congenital renal anomalies,such as horse-shoe and ectopic kidneys.And borderline stones that branched to one major calyx only were also not included.From 3-DR images,the number of stone branching into minor renal calices was recorded.We made "3" as the branch breakdown between groups.And the patients were divided into four groups.The number of percutaneous tract,operative time,staged PNL,intra-operative blood loss,complications,stone clearance rate,and postoperative hospital day were compared.Results The 371 patients (386 renal units)underwent PNL successfully,included 144 single-tract PNL,242 multi-tract PNL,97 staged PNL.The average operative time was (100±50) minutes; the average intra-operative blood loss was (83 ± 67) ml.The stone clearance rate were 61.7% (3 days) and 79.5% (3 months).The postoperative hospital stay was (6.9 ± 3.4) days.A significantly higher ratio of multi-tract (x2 =212.220,P < 0.01) and staged PNL (x2 =49.679,P < 0.01),longer operative time (F =4.652,P < 0.01) and postoperative hospital day (F =2.067,P =0.043) and lower rate of stone clearance (x2 =10.691 and 47.369,P < 0.05) were found in PNL for calculi with stone branch number ≥ 5.There was no statistically meaningful difference among the 4 groups based on Clavien complication system (P =0.460).Conclusion The possibility of multi-tract and staged PNL,lower rate of stone clearance and longer postoperative hospital day increase for staghorn calculi with stone branch number more than 5.

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