超声引导经皮肾镜取石术治疗无功能萎缩肾内大结石的疗效。

Outcomes of ultrasound-guided percutaneous nephrolithotomy for the treatment of large stones within non-functioning atrophic kidneys.

机构信息

Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.

出版信息

Int J Urol. 2021 Mar;28(3):254-259. doi: 10.1111/iju.14440. Epub 2020 Dec 22.

DOI:10.1111/iju.14440

PMID:33354843

Abstract

OBJECTIVES

To evaluate outcomes in patients who underwent total ultrasound-guided percutaneous nephrolithotomy for the management of large stones (>2 cm) within non-functioning atrophic kidneys, and to identify risk factors associated with postoperative persistence of urinary tract infection symptoms in such patients.

METHODS

Between December 2014 and May 2019, 56 patients with large stones within non-functioning atrophic kidneys were treated at Beijing Tsinghua Changgung Hospital, Beijing, China, with total ultrasound-guided percutaneous nephrolithotomy. Factors including age, sex, previous medical history, stone burden, stone composition, stone-free rate, complication rate and postoperative urinary tract infection symptoms were retrospectively evaluated. Uni- and multivariate analyses were carried out to identify risk factors that predict persistence of urinary tract infection symptoms after percutaneous nephrolithotomy in such patients.

RESULTS

The final stone-free rate after auxiliary treatments was 87.5%. The overall complication rate was 17.9%. After a median follow-up period of 12 months (range 6-40 months), three patients (5.4%) ultimately underwent nephrectomy. A total of 44 patients (78.6%) had no symptoms of urinary tract infection during follow up, whereas 63.6% of patients with diabetes continued to show persistent urinary tract infection symptoms at the latest follow up. Five patients (8.9%) showed improved total renal function, while most patients (83.9%) showed a stable estimated glomerular filtration rate. Diabetes was the only factor showing statistical significance in both univariate and multivariate analyses that predicted persistence of urinary tract infection symptoms after treatment with percutaneous nephrolithotomy.

CONCLUSIONS

Ultrasound-guided percutaneous nephrolithotomy is a safe and feasible procedure that can be carried out in patients with large stones within non-functioning atrophic kidneys. However, for such patients with diabetes, percutaneous nephrolithotomy is not recommended.

摘要

目的

评估超声引导下经皮肾镜碎石术治疗无功能萎缩肾内大结石（>2cm）患者的疗效，并分析此类患者术后尿路感症状持续存在的相关危险因素。

方法

回顾性分析 2014 年 12 月至 2019 年 5 月在北京清华长庚医院接受超声引导下经皮肾镜碎石术治疗的 56 例无功能萎缩肾内大结石患者的临床资料。分析患者的年龄、性别、既往病史、结石负荷、结石成分、结石清除率、并发症发生率和术后尿路感染症状等。采用单因素和多因素分析探讨影响经皮肾镜碎石术后尿路感染症状持续存在的危险因素。

结果

辅助治疗后结石清除率为 87.5%。总体并发症发生率为 17.9%。中位随访时间为 12 个月（6~40 个月），3 例（5.4%）患者最终行肾切除术。44 例（78.6%）患者在随访期间无尿路感染症状，而糖尿病患者中 63.6%在末次随访时仍存在持续尿路感染症状。5 例（8.9%）患者总肾功能改善，大多数患者（83.9%）估算肾小球滤过率稳定。糖尿病在单因素和多因素分析中均为预测经皮肾镜碎石术后尿路感染症状持续存在的唯一因素。