孤立腎結(jié)石患者經(jīng)皮腎鏡術(shù)后腎功能轉(zhuǎn)歸的影響因素研究
發(fā)布時(shí)間：2018-07-29 15:36
【摘要】：目的：研究影響孤立腎并泌尿系結(jié)石患者接受mPCNL術(shù)后腎功能變化的因素,為臨床治療提供參考。 方法：自2012年3月至2013年5月,收集了中南大學(xué)湘雅醫(yī)院泌尿外科采用mPCNL治療并且符合入選標(biāo)準(zhǔn)的73例孤立腎并泌尿系結(jié)石患者的資料進(jìn)行研究。根據(jù)患者術(shù)后1年腎功能情況將患者分為腎功能惡化組：術(shù)后1年GFR較術(shù)前下降超過(guò)5%；腎功能穩(wěn)定或好轉(zhuǎn)組：術(shù)后1年GFR較術(shù)前下降不到5%或高于術(shù)前。觀察指標(biāo)包括人口學(xué)資料(年齡、性別、BMI),是否有上尿路手術(shù)史,是否合并糖尿病、高血壓、蛋白尿,結(jié)石表面積,術(shù)前腎皮質(zhì)厚度,術(shù)前腎功能,術(shù)前尿常規(guī)及尿培養(yǎng)情況,手術(shù)時(shí)間,術(shù)中出血量等。先使用t檢驗(yàn)或x2檢驗(yàn)進(jìn)行單變量分析,再使用二元logistic回歸篩選出此類患者術(shù)后腎功能惡化的危險(xiǎn)因素及保護(hù)因素,從而對(duì)影響孤立腎結(jié)石患者mPCNL術(shù)后腎功能變化情況進(jìn)行探討。 結(jié)果：本實(shí)驗(yàn)73例患者中47例術(shù)后腎功能穩(wěn)定或好轉(zhuǎn),26例術(shù)后腎功能惡化,全部73名患者術(shù)后1月復(fù)查KUB,62名患者結(jié)石完全取凈,結(jié)石清除率為84.9%。經(jīng)單變量分析及二元logistic回歸分析,術(shù)前腎皮質(zhì)厚度是術(shù)后腎功能情況的保護(hù)因素(B=-1.233,OR=0.292),而蛋白尿(B=1.607,OR=4.990)、尿路感染(B=1.751,OR=5.763)以及高血壓(B=1.262,OR=3.533)是術(shù)后腎功能情況的危險(xiǎn)因素。 結(jié)論：孤立腎并泌尿系結(jié)石患者行PCNL術(shù)后腎功能的轉(zhuǎn)歸與多種因素有關(guān)。術(shù)前腎皮質(zhì)厚度較厚的患者術(shù)后腎功能維持穩(wěn)定或好轉(zhuǎn)的可能性較大,反之術(shù)前腎皮質(zhì)厚度較薄的患者術(shù)后腎功能惡化的可能性較大；而術(shù)前尿蛋白陽(yáng)性、有尿路感染、合并高血壓病的患者術(shù)后腎功能較術(shù)前變差的可能性較大,反之無(wú)這些合并疾病的患者術(shù)后腎功能好轉(zhuǎn)或維持穩(wěn)定的可能性較大。
[Abstract]:Objective: to study the influencing factors of renal function after mPCNL in patients with solitary kidney and urinary calculi, and to provide reference for clinical treatment. Methods: from March 2012 to May 2013, 73 patients with solitary kidney and urinary calculi who were treated with mPCNL in Xiangya Hospital of Central South University were studied. According to the condition of renal function in one year after operation, the patients were divided into two groups: one year after operation, the GFR decreased by more than 5% than that before operation, and in the group of stable or improved renal function, the GFR decreased less than 5% or higher than that before operation at 1 year after operation. The data included demographic data (age, sex and BMI), history of upper urinary tract surgery, diabetes mellitus, hypertension, proteinuria, stone surface area, preoperative renal cortex thickness, preoperative renal function, preoperative urine routine and urine culture. Operative time, intraoperative bleeding, etc. T test or x2 test was used for univariate analysis, then binary logistic regression was used to screen out the risk factors and protective factors of renal function deterioration after operation. The changes of renal function after mPCNL in patients with solitary renal calculi were discussed. Results: in this study, 47 cases of renal function were stable or improved after operation, 26 cases of renal function deteriorated after operation. All 73 cases of KUBU 62 patients were completely removed stones, the stone clearance rate was 84.9%. By univariate analysis and binary logistic regression analysis, renal cortex thickness before operation was the protective factor of renal function after operation (BH-1. 233 OR0.292), while proteinuria (B1. 607), urinary tract infection (B1. 751) and hypertension (B1. 262 OR3. 533) were risk factors of renal function after operation. Conclusion: the prognosis of renal function after PCNL in patients with solitary kidney and urinary calculi is related to many factors. The patients with thicker thickness of renal cortex were more likely to maintain stable or improve renal function after operation, whereas patients with thinner thickness of renal cortex before operation were more likely to deteriorate renal function after operation, while patients with positive urinary protein before operation had urinary tract infection, while patients with thicker thickness of renal cortex before operation were more likely to deteriorate renal function after operation. The possibility of renal function deterioration after operation in patients with hypertension was higher than that in patients without hypertension, whereas the possibility of improving or maintaining stability of renal function in patients without these diseases was higher.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.2
本文編號(hào)：2153145
[Abstract]:Objective: to study the influencing factors of renal function after mPCNL in patients with solitary kidney and urinary calculi, and to provide reference for clinical treatment. Methods: from March 2012 to May 2013, 73 patients with solitary kidney and urinary calculi who were treated with mPCNL in Xiangya Hospital of Central South University were studied. According to the condition of renal function in one year after operation, the patients were divided into two groups: one year after operation, the GFR decreased by more than 5% than that before operation, and in the group of stable or improved renal function, the GFR decreased less than 5% or higher than that before operation at 1 year after operation. The data included demographic data (age, sex and BMI), history of upper urinary tract surgery, diabetes mellitus, hypertension, proteinuria, stone surface area, preoperative renal cortex thickness, preoperative renal function, preoperative urine routine and urine culture. Operative time, intraoperative bleeding, etc. T test or x2 test was used for univariate analysis, then binary logistic regression was used to screen out the risk factors and protective factors of renal function deterioration after operation. The changes of renal function after mPCNL in patients with solitary renal calculi were discussed. Results: in this study, 47 cases of renal function were stable or improved after operation, 26 cases of renal function deteriorated after operation. All 73 cases of KUBU 62 patients were completely removed stones, the stone clearance rate was 84.9%. By univariate analysis and binary logistic regression analysis, renal cortex thickness before operation was the protective factor of renal function after operation (BH-1. 233 OR0.292), while proteinuria (B1. 607), urinary tract infection (B1. 751) and hypertension (B1. 262 OR3. 533) were risk factors of renal function after operation. Conclusion: the prognosis of renal function after PCNL in patients with solitary kidney and urinary calculi is related to many factors. The patients with thicker thickness of renal cortex were more likely to maintain stable or improve renal function after operation, whereas patients with thinner thickness of renal cortex before operation were more likely to deteriorate renal function after operation, while patients with positive urinary protein before operation had urinary tract infection, while patients with thicker thickness of renal cortex before operation were more likely to deteriorate renal function after operation. The possibility of renal function deterioration after operation in patients with hypertension was higher than that in patients without hypertension, whereas the possibility of improving or maintaining stability of renal function in patients without these diseases was higher.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.2
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