经皮肾镜取石术后输尿管结石顺行性迁移的发生率及危险因素

Frequency and risk factors for antegrade ureteral stone migration after percutaneous nephrolithotomy.

作者信息

Barba Hector S, Villeda-Sandoval Christian Isaac, Mendez-Probst Carlos E

机构信息

Department of Urology at Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.

出版信息

Cent European J Urol. 2020;73(3):355-361. doi: 10.5173/ceju.2020.0023. Epub 2020 Aug 29.

DOI:10.5173/ceju.2020.0023

PMID:33133665

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7587484/

Abstract

INTRODUCTION

Percutaneous nephrolithotomy (PCNL) is the minimally invasive procedure of choice for the treatment of large and/or complex nephrolithiasis. Migration of residual fragments (RFs) into the ureter after PCNL is presumed to be uncommon. However, should associated stone-related events (SREs) occur, ancillary procedures may be required. The objective of this study was to describe the frequency and to analyze predictors of antegrade migration of RFs after PCNL.

MATERIAL AND METHODS

A case-control study of patients who underwent PCNL for nephrolithiasis and had a postoperative computed tomography available within 48 hours was performed. Descriptive statistics and logistic regression analysis were carried out.

RESULTS

The final sample included 169 interventions. Mean age was 49 ±13 years, median maximum stone size was 26 (7 to 87) mm and mean stone density was 835 (70 to 2022) Hounsfield Units (HUs). 7.1% of the patients experienced migration of RFs into the ureter after PCNL, of whom 41.6% suffered SREs. Lithotripsy was performed using ultrasonic (67.5%), laser (23.7%), and pneumatic (14.8%) technologies. Univariate analysis found female gender (OR 4.1, p = 0.02) height ≥1.68 m (OR 5.52, p = 0.009), middle (OR 6.71, p = 0.01) and upper (OR 3.59, p = 0.04) caliceal location, staghorn calculi (OR 4.72, p = 0.02), stone area (OR 1.001, p = 0.03), lasertripsy (OR 3.61, p = 0.03) and operative time (OR 1.007, p = 0.02) statistically significant for migration of SFs into the ureter after PCNL. Of these, only height ≥1.68 m (OR 7.17, p = 0.01) and staghorn nephrolithiasis (OR 13.27, p = 0.02) remained independent predictors in the multivariate analysis with an area under the curve of 0.69.

CONCLUSIONS

71.% of patients undergoing PCNL had a SF migrating to the ureter. Of these 41% suffered a SRE that required ancilliary interventions. Staghorn nephrolithiasis and ≥1.68 mts of height were found to predict this event.

摘要

引言

经皮肾镜取石术（PCNL）是治疗大型和/或复杂性肾结石的首选微创手术。PCNL术后残余结石碎片（RFs）迁移至输尿管的情况被认为并不常见。然而，若发生相关的结石相关事件（SREs），可能需要辅助手术。本研究的目的是描述PCNL术后RFs顺行迁移的频率并分析其预测因素。

材料与方法

对接受PCNL治疗肾结石且术后48小时内有计算机断层扫描结果的患者进行病例对照研究。进行描述性统计和逻辑回归分析。

结果

最终样本包括169例手术。平均年龄为49±13岁，结石最大径中位数为26（7至87）mm，平均结石密度为835（70至2022）亨氏单位（HUs）。7.1%的患者在PCNL术后出现RFs迁移至输尿管，其中41.6%发生了SREs。采用超声（67.5%）、激光（23.7%）和气压弹道（14.8%）技术进行碎石。单因素分析发现，女性（比值比[OR]4.1，p = 0.02）、身高≥1.68 m（OR 5.52，p = 0.009）、中盏（OR 6.71，p = 0.01）和上盏位置（OR 3.59，p = 0.04）、鹿角形结石（OR 4.72，p = 0.02）、结石面积（OR 1.001，p = 0.03）、激光碎石（OR 3.61，p = 0.03）和手术时间（OR 1.007，p = 0.02）对PCNL术后SFs迁移至输尿管具有统计学意义。其中，在多因素分析中，只有身高≥1.68 m（OR 7.17，p = 0.01）和鹿角形肾结石（OR 13.27，p = 0.02）仍然是独立预测因素，曲线下面积为0.69。