Multi-factor analysis of factors influencing the stone-free rate after percutaneous nephrolithotomy in kidney calculi

doi:10.3877/cma.j.issn.1674-3253.2018.02.012

Abstract

Abstract:

Objective

To study the factors influencing the stone-free rate after percutaneous nephrolithotomy (PCNL) in kidney calculi.

Methods

Clinical data of 125 patients with nephrolithiasis underwent PCNL from May 2011 to May 2016 were retrospectively analyzed. Ultrasonic and KUB+IVU and computed tomography (CT) were used to evaluate the anatomy of the renal collecting system, area of calculus, degree of hydronephrosis, distribution of calculus, number of renal calculi and CT value of the calculi. Number of puncture channels, length of the puncture channel, size of the puncture channel, blood loss during operation and experience of the surgeon were recorded according to the operation records. Univariate analysis was performed for each factor. Factors found to be significantly different that were further analyzed using multivariate logistic regression analysis.

Results

The stones of 92 cases were cleared, clearance rate was 73.6%. Univariate analysis showed that the following factors were associated with the stone-free rate: area of calculus, distribution of calculus, abnormal anatomy of the renal collecting system, number of renal calculi, length of the puncture channel, blood loss during operation, experience of the surgeon. Multivariate analysis showed that the following risk factors were independently associated with the stone-free rate: area of calculus, distribution of calculus, abnormal anatomy of the renal collecting system, number of kidney calculi. Surgeon's experience was a protective factor associated with the stone-free rate.

Conclusion

Abnormal anatomy of the renal collecting system, size of the calculi and distribution in the calyx were independent factors of the effect of PCNL and can be used to evaluate the effect of surgery. Surgeon's experience was beneficial to increasing the stone-free rate.

Key words: Kidney calculi, Percutaneous nephrolithotomy, Stone-free rate

Longfei Zhong, Qiaoxing Li, Dongyan Liang, Yong Wang, Weilu Wang. Multi-factor analysis of factors influencing the stone-free rate after percutaneous nephrolithotomy in kidney calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(02): 116-120.

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References 18

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因素		清石率[例（%）]	χ²值	df值	P值
性别		?	?	?	?
?	男性	54(75)	00.171	1	0.679
?	女性	38(72)	?	?	?
患肾侧别		?	?	?	?
?	左侧	43(73)	00.330	1	0.566
?	右侧	45(68)	?	?	?
泌尿系感染		?	?	?	?
?	无	29(81)	01.259	1	0.262
?	有	63(71)	?	?	?
肾脏既往手术史		?	?	?	?
?	无	83(76)	01.623	1	0.203
?	有	09(60)	?	?	?
结石体表面积		?	?	?	?
?	≤500 mm²	43(92)	18.308	2	0.000
?	500～800 mm²	33(73)	?	?	?
?	>800 mm²	16(49)	?	?	?
肾积水程度		?	?	?	?
?	≤20 mm	28(62)	00.923	2	0.630
?	20～40 mm	37(77)	?	?	?
?	>40 mm	27(75)	?	?	?
结石解剖分布		?	?	?	?
?	上盏	21(84)	30.286	6	0.000
?	中盏	19(86)	?	?	?
?	下盏	12(75)	?	?	?
?	肾盂	26(93)	?	?	?
?	肾盏憩室	08(57)	?	?	?
?	部分鹿角型	04(33)	?	?	?
?	完全鹿角型	02(25)	?	?	?
肾脏集合系统解剖异常		?	?	?	?
?	无	83(81)	17.236	1	0.000
?	有	09(39)	?	?	?
受累肾盏数		?	?	?	?
?	≤2个	81(84)	27.725	1	0.000
?	>2个	?	?	?	?
CT值		?	?	?	?
?	≤950 HU	43(90)	00.001	1	0.975
?	>950 HU	49(73)	?	?	?
穿刺通道长度		?	?	?	?
?	≤8 cm	59(82)	06.085	1	0.014
?	>8 cm	33(62)	?	?	?
穿刺通道数		?	?	?	?
?	一通道	79(73)	00.193	1	0.660
?	二通道	13(81)	?	?	?
穿刺通道大小		?	?	?	?
?	14 F	15(68)	0.790	3	0.852
?	16 F	32(78)	?	?	?
?	18 F	27(73)	?	?	?
?	20 F	18(72)	?	?	?
术中活动性出血		?	?	?	?
?	无	57(83)	6.433	1	0.011
?	有	35(63)	?	?	?
术者经验		?	?	?	?
?	≤60例	37(64)	5.356	1	0.021
?	>60例	55(82)	?	?	?

因素		清石率[例（%）]	χ²值	df值	P值
性别		?	?	?	?
?	男性	54(75)	00.171	1	0.679
?	女性	38(72)	?	?	?
患肾侧别		?	?	?	?
?	左侧	43(73)	00.330	1	0.566
?	右侧	45(68)	?	?	?
泌尿系感染		?	?	?	?
?	无	29(81)	01.259	1	0.262
?	有	63(71)	?	?	?
肾脏既往手术史		?	?	?	?
?	无	83(76)	01.623	1	0.203
?	有	09(60)	?	?	?
结石体表面积		?	?	?	?
?	≤500 mm²	43(92)	18.308	2	0.000
?	500～800 mm²	33(73)	?	?	?
?	>800 mm²	16(49)	?	?	?
肾积水程度		?	?	?	?
?	≤20 mm	28(62)	00.923	2	0.630
?	20～40 mm	37(77)	?	?	?
?	>40 mm	27(75)	?	?	?
结石解剖分布		?	?	?	?
?	上盏	21(84)	30.286	6	0.000
?	中盏	19(86)	?	?	?
?	下盏	12(75)	?	?	?
?	肾盂	26(93)	?	?	?
?	肾盏憩室	08(57)	?	?	?
?	部分鹿角型	04(33)	?	?	?
?	完全鹿角型	02(25)	?	?	?
肾脏集合系统解剖异常		?	?	?	?
?	无	83(81)	17.236	1	0.000
?	有	09(39)	?	?	?
受累肾盏数		?	?	?	?
?	≤2个	81(84)	27.725	1	0.000
?	>2个	?	?	?	?
CT值		?	?	?	?
?	≤950 HU	43(90)	00.001	1	0.975
?	>950 HU	49(73)	?	?	?
穿刺通道长度		?	?	?	?
?	≤8 cm	59(82)	06.085	1	0.014
?	>8 cm	33(62)	?	?	?
穿刺通道数		?	?	?	?
?	一通道	79(73)	00.193	1	0.660
?	二通道	13(81)	?	?	?
穿刺通道大小		?	?	?	?
?	14 F	15(68)	0.790	3	0.852
?	16 F	32(78)	?	?	?
?	18 F	27(73)	?	?	?
?	20 F	18(72)	?	?	?
术中活动性出血		?	?	?	?
?	无	57(83)	6.433	1	0.011
?	有	35(63)	?	?	?
术者经验		?	?	?	?
?	≤60例	37(64)	5.356	1	0.021
?	>60例	55(82)	?	?	?

因素	B	S.E.	Wald	P值	OR	95%CI
结石体表面积	1.372	0.511	7.215	0.007	3.943	1.449～10.732
结石解剖分布	0.469	0.178	6.918	0.009	1.599	1.127～2.2680
肾脏集合系统解剖异	1.523	0.693	4.832	0.028	4.585	1.179～17.826
受累肾盏数	1.452	0.635	5.227	0.022	4.273	1.230～14.844
穿刺通道长度	-2.2540	1.485	2.303	0.129	0.105	0.006～1.9290
术中活动性出血	0.315	1.406	0.050	0.823	1.371	0.087～21.558
术者经验	-1.4220	0.618	5.289	0.021	0.241	0.072～0.8100

因素	B	S.E.	Wald	P值	OR	95%CI
结石体表面积	1.372	0.511	7.215	0.007	3.943	1.449～10.732
结石解剖分布	0.469	0.178	6.918	0.009	1.599	1.127～2.2680
肾脏集合系统解剖异	1.523	0.693	4.832	0.028	4.585	1.179～17.826
受累肾盏数	1.452	0.635	5.227	0.022	4.273	1.230～14.844
穿刺通道长度	-2.2540	1.485	2.303	0.129	0.105	0.006～1.9290
术中活动性出血	0.315	1.406	0.050	0.823	1.371	0.087～21.558
术者经验	-1.4220	0.618	5.289	0.021	0.241	0.072～0.8100

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