Yamashita Shimpei, Kohjimoto Yasuo, Iba Akinori, Kikkawa Kazuro, Hara Isao
a Department of Urology , Wakayama Medical University , Wakayama , Japan.
Scand J Urol. 2017 Apr;51(2):159-164. doi: 10.1080/21681805.2017.1284897. Epub 2017 Feb 13.
The aim of this study was to identify the predictors of treatment results after endoscopic combined intrarenal surgery (ECIRS).
A retrospective analysis was conducted of 75 patients with renal stones who underwent ECIRS and a preoperative non-contrast computed tomography (NCCT) examination. The stone-free rate (SFR), number of primary procedures and perioperative complications were investigated, and the predictors contributing to these three outcomes were analyzed. Stone-free status was determined within 3 months postoperatively using NCCT. The number of primary procedures (defined as ECIRS and/or conventional transurethral lithotripsy) and perioperative complications were reviewed using the medical records.
The final SFR after further treatment was 69.3% (52/75 cases). About 70% of all cases underwent only one primary procedure, and the average number of primary procedures was 1.41. From multivariate analysis, increasing stone size (p < 0.001), increasing Charlson Comorbidity Index (p = 0.043) and unfavorable nephrostomy tract (p = 0.046) were independent significant predictors of residual stones, and increasing stone size was the only independent significant predictor of two or more primary procedures (p = 0.017). Overall, 24 out of 75 patients (32%) experienced one or more perioperative complications. Based on multivariate analysis, female gender (p = 0.014) and increasing Hounsfield units (p = 0.006) were significantly associated with perioperative complications.
Increasing stone size was an independent predictor for residual stone and multiple procedures of ECIRS. In contrast, increasing number of involved calyces was not predictive, which may be responsible for the combined antegrade and retrograde access. Female gender and increasing Hounsfield units of the stone were significantly associated with perioperative complications of ECIRS, and ECIRS for these patients requires careful attention.
本研究旨在确定经皮肾镜联合腔内手术（ECIRS）后治疗效果的预测因素。
对75例行ECIRS及术前非增强计算机断层扫描（NCCT）检查的肾结石患者进行回顾性分析。研究无结石率（SFR）、初次手术次数及围手术期并发症，并分析影响这三个结果的预测因素。术后3个月内使用NCCT确定无结石状态。通过病历回顾初次手术次数（定义为ECIRS和/或传统经尿道碎石术）及围手术期并发症。
进一步治疗后的最终无结石率为69.3%（52/75例）。约70%的病例仅接受了一次初次手术，初次手术的平均次数为1.41次。多因素分析显示，结石体积增大（p<0.001）、查尔森合并症指数增加（p=0.043）及肾造瘘通道不佳（p=0.046）是残余结石的独立显著预测因素，结石体积增大是两次或更多次初次手术的唯一独立显著预测因素（p=0.017）。总体而言，75例患者中有24例（32%）发生了一种或多种围手术期并发症。多因素分析显示，女性（p=0.014）及亨氏单位增加（p=0.006）与围手术期并发症显著相关。
结石体积增大是ECIRS术后残余结石及多次手术的独立预测因素。相比之下，受累肾盏数量增加并无预测价值，这可能与顺行和逆行联合入路有关。女性及结石亨氏单位增加与ECIRS围手术期并发症显著相关，对这些患者进行ECIRS时需要格外关注。
