经皮肾镜碎石术部分无管化安全性及可行性的探讨

刘军; 何炜; 娄彦亭; 陆兆祥; 石栋; 汤玉锐

doi:10.16766/j.cnki.issn.1674-4152.003710

经皮肾镜碎石术部分无管化安全性及可行性的探讨

doi: 10.16766/j.cnki.issn.1674-4152.003710

安徽医科大学附属巢湖医院泌尿外科，安徽合肥 238000

基金项目:

安徽省教育厅高校科学研究项目 KJ2021A0335

详细信息

通讯作者:
何炜，E-mail: hw3800@sina.com

中图分类号: R692.4
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- 文章访问数: 22
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出版历程
- 收稿日期: 2024-02-05
- 网络出版日期: 2024-12-28

Safety and feasibility of partial tubeless percutaneous nephrolithotripsy

Department of Urology, the Chaohu Hospital of Anhui Medical University, Hefei, Anhui 238000, China

摘要

摘要: 目的探讨经皮肾镜碎石术部分无管化(PCNL)的安全性和临床疗效。方法选取安徽医科大学附属巢湖医院2021年1月—2023年6月收治的87例肾输尿管结石患者，按照手术方式分为传统经皮肾镜(留置肾造瘘管和双J管)手术组47例和经皮肾镜部分无管化(仅留置双J管)手术组40例。所有87例手术均由同一组医生完成，比较2组术前和围手术期资料，分析经皮肾镜手术并发症的影响因素。结果传统经皮肾镜手术组术后住院时间[7.00(6.00, 9.00)d vs. 5.00(4.00, 6.00)d]、首次下床时间[4.00(3.00, 5.00)d vs. 2.00(2.00, 3.00)d]、术后并发症发生率[17例(36.2%) vs. 3例(7.5%)]、术后VAS评分[7.00(7.00, 8.00)分vs. 5.00(5.00, 5.00)分]与经皮肾镜部分无管化手术组比较差异均有统计学意义(P < 0.05)。除性别外，2组术前年龄、BMI、STONE评分、术前尿白细胞、合并糖尿病、高血压、心脏病比较，差异均无统计学意义(P>0.05)。多因素分析显示，结石STONE评分与手术方式是术后并发症的独立影响因素。结论经皮肾镜部分无管化在手术安全性、术后VAS评分、术后恢复时间、住院时间、治疗费用、治疗效率方面具有显著优势，值得推广。
- 经皮肾镜碎石术 /
- 部分无管化 /
- 并发症
Abstract: Objective To investigate the safety and clinical efficacy of partial tubeless percutaneous nephrolithotripsy(PCNL). Methods A total of 87 patients with renal ureteral stones admitted to the Chaohu Hospital of Anhui Medical University between January 2021 to June 2023 were divided into 47 cases in the traditional percutaneous nephrolithotomy (with indwelling nephrostomy tube and double J-tube) surgical group and 40 cases in the percutaneous nephrolithotomy partially untubed (with indwelling double J-tube only) surgical group according to surgical methods. All 87 surgical procedures were performed by the same surgical team. The data pertaining to the preoperative and perioperative periods, along with the factors that may potentially influence the incidence factors that may potentially influence the incidence of complications associated with percutaneous nephrolithotomy were comparable between the two groups. Results In the traditional percutaneous nephroscopic surgery group, the postoperative hospitalization duration [7.00 (6.00, 9.00) d vs. 5.00 (4.00, 6.00) d], first time out of bed [4.00 (3.00, 5.00) d vs. 2.00 (2.00, 3.00) d], incidence of postoperative complications [17 cases (36.2%) vs. 3 cases (7.5%)] and postoperative VAS score [7.00 (7.00, 8.00) vs. 5.00 (5.00, 5.00)] were significantly different from those in the percutaneous nephroscopic partial tubeless surgery group (P < 0.05). With the exception of gender, the two groups exhibited statistically significant differences in preoperative age, BMI and STONE score. Preoperative urinary leukocytes, comorbidities of diabetes mellitus, hypertension, and cardiac disease did not reach statistical significance (P>0.05). A multifactorial analysis revealed that STONE score and surgical approach were independent risk factors for postoperative complications. Conclusion Percutaneous nephrolithotomy for partial tubelessness offers significant advantages in terms of surgical safety, postoperative VAS score, postoperative recovery time, average hospital stay, treatment cost, and treatment efficiency. It is therefore a procedure that merits further promotion.
- Percutaneous nephrolithotripsy /
- Partial actubation /
- Complications

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图 1 部分无管化经皮肾镜手术过程中使用止血棒止血

注：A为经皮肾镜术中发现肾皮质通道有小血管出血；B为使用止血棒电凝处理；C为皮质无出血。

Figure 1. Use of hemostatic sticks for hemostasis during partial tubeless percutaneous nephrolithotomy

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表 1 2组肾输尿管结石患者一般资料比较

Table 1. Comparison of general data of patients with nephroureteral calculi in the two groups

组别	例数	年龄(x±s, 岁)	性别(例)		BMI(x±s)	Stone评分[M(P₂₅, P₇₅)，分]	术前尿白细胞(例)		合并糖尿病(例)	合并高血压(例)	合并心脏病(例)	结石直径分类(例)		肾积水(例)		结石负荷(例)
组别	例数	年龄(x±s, 岁)	男性	女性	BMI(x±s)	Stone评分[M(P₂₅, P₇₅)，分]	<100个/μL	≥100个/μL	合并糖尿病(例)	合并高血压(例)	合并心脏病(例)	<2 cm	≥2 cm	无	有	单发	多发
传统经皮肾镜组	47	54.72±12.23	36	11	24.32±3.29	7.00(6.00, 8.00)	35	12	5	6	1	17	30	20	27	9	38
部分无管化组	40	54.70±11.66	22	18	23.62±3.79	7.00(7.00, 8.00)	26	14	3	3	2	13	27	15	25	13	27
统计量		0.009^a	4.535^b		0.927^a	968.000^c	0.924^b		0.255^b	0.646^b	0.535^b	0.129^b		0.229^b		2.039^b
P值		0.993	0.033		0.356	0.804	0.358		0.721	0.498	0.592	0.720		0.666		0.216
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组肾输尿管结石患者围手术期指标比较

Table 2. Comparison of perioperative indexes in the two groups of patients with renal ureteral calculi

组别	例数	手术时间(x±s, min)	术后血红蛋白下降量[M(P₂₅, P₇₅)，g/L]		术后PCT[M(P₂₅, P₇₅)，ng/mL]			术后住院时间[M(P₂₅, P₇₅)，d]
传统经皮肾镜组	47	147.96±46.84	11.00(5.00, 18.00)		0.33(0.30, 0.60)			7.00(6.00, 9.00)
部分无管化组	40	115.63±36.29	9.50(4.00, 17.75)		0.30(0.30, 0.49)			5.00(4.00, 6.00)
统计量		3.551^a	911.500^b		860.500^b			366.000^b
P值		0.001	0.808		0.482			<0.001

组别	例数	术后首次下床时间[M(P₂₅, P₇₅)，d]	术后并发症[例(%)]	术后VAS评分[M(P₂₅, P₇₅)，分]	术后焦虑(例)	术后睡眠时间(例)		术后有意义结石残留(例)	住院费用(x±s，元)
组别	例数	术后首次下床时间[M(P₂₅, P₇₅)，d]	术后并发症[例(%)]	术后VAS评分[M(P₂₅, P₇₅)，分]	术后焦虑(例)	<6 h	≥6 h	术后有意义结石残留(例)	住院费用(x±s，元)
传统经皮肾镜组	47	4.00(3.00, 5.00)	17(36.2)	7.00(7.00, 8.00)	6	37	10	10	16 320±2 114
部分无管化组	40	2.00(2.00, 3.00)	3(7.5)	5.00(5.00, 5.00)	3	30	10	4	16 037±1 703
统计量		347.000^b	10.033^c	52.000^b	0.646^c	0.169^c		2.035^c	0.679^a
P值		<0.001	0.002	<0.001	0.498	0.681		0.154	0.499
注：^a为t值，^b为Z值，^c为χ²值。

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表 3 肾输尿管结石患者术后并发症影响因素的单因素分析

Table 3. Univariate analysis of influencing factors of postoperative complications in patients with renal ureteral calculi

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	-0.013	0.021	0.368	0.544	0.987	0.947~1.029
性别	-0.868	0.613	2.000	0.157	0.420	0.126~1.398
BMI	0.047	0.071	0.443	0.506	1.049	0.912~1.206
Stone评分	0.634	0.214	8.772	0.003	1.885	1.239~2.867
手术时间	0.021	0.006	10.339	0.001	1.021	1.008~1.034
手术方式	1.944	0.673	8.354	0.004	6.989	1.870~26.122
糖尿病	0.122	0.859	0.020	0.887	1.130	0.210~6.088
高血压	-0.946	1.093	0.750	0.387	0.388	0.046~3.306
心脏病	-1.992	1.253	2.527	0.112	0.136	0.012~1.590
术前尿白细胞	0.003	0.003	0.598	0.439	1.003	0.996~1.009
注：各变量赋值如下，女性=1，男性=2；手术方式，传统经皮肾镜组=1，部分无管化组=2；无糖尿病=0，有糖尿病=1；无高血压=0，有高血压=1；无心脏病=0，有心脏病=1；无并发症=0，有并发症=1；其余连续性变量以实际值赋值。

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表 4 肾输尿管结石患者术后并发症影响因素的多因素分析

Table 4. Multivariate analysis of influencing factors of postoperative complications in patients with renal ureteral calculi

变量	B	SE	Waldχ²	P值	OR值	95% CI
Stone评分	0.507	0.237	4.554	0.033	1.660	1.042~2.644
手术时间	0.110	0.007	2.238	0.135	1.011	0.997~1.026
传统经皮肾镜/部分无管化经皮肾镜	1.596	0.719	4.924	0.026	4.931	1.205~20.186

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