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影响鹿角形结石一期经皮肾镜取石术结石清除率的因素:一项15年的单中心经验

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years.

作者信息

Atmoko Widi, Birowo Ponco, Rasyid Nur

机构信息

Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia.

出版信息

F1000Res. 2016 Aug 30;5:2106. doi: 10.12688/f1000research.9509.2. eCollection 2016.

Abstract

Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( = 0.01), stone burden ( = < 0.001), and type of anesthesia ( = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; 0.00] were significant independent risk factors for stone-free.

摘要

经皮肾镜取石术治疗鹿角形结石对泌尿外科医生来说具有挑战性,因为很难清除所有结石。本研究的目的是在一家单一的、三级转诊的腔内泌尿外科结石中心,对大量患者进行初次经皮肾镜取石术治疗鹿角形结石后无结石率的相关因素进行评估。我们收集了2000年1月至2015年12月期间的病历数据。共对345例鹿角形结石患者进行了初次经皮肾镜取石术。本研究包括部分和完全鹿角形结石,且未作区分。无结石定义为首次接受经皮肾镜取石术后无残留结石。对初次经皮肾镜取石术治疗鹿角形结石后无结石率相关的单因素分析中的显著因素,进一步采用多因素回归分析。患者平均年龄为52.23±10.38岁。经皮肾镜取石术单一疗法的无结石率为62.6%。平均手术时间为79.55±34.46分钟。平均住院时间为4.29±3.00天。采用卡方检验,同侧开放性肾结石手术史(P = 0.01)、结石负荷(P = < 0.001)和麻醉类型(P = 0.04)对无结石率有显著影响。多因素分析显示,同侧开放性肾结石手术史[比值比(OR)0.48;95%可信区间(CI)0.28 - 0.81;P = 0.01]和结石负荷[OR 0.28;95% CI 0.18 - 0.45;P = 0.00]是无结石的显著独立危险因素。

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