經皮腎造廔結石手術:影響結石清除率之因子
歐正峰1、蔡宗佑1、古博文1、鍾旭東1
1亞東紀念醫院外科部泌尿科
Factors affecting stone free rate following percutaneous nephrolithotomy: A new look at an old issue
Au Chin Fong1, Chung-You Tsai1,Po-Wen Ku1, Shiu-Dong Chung1
1Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
Purpose: Renal stones is a common disease and percutaneous nephrolithotomy (PCNL) is commonly used operation. The purpose of this study is to evaluate the factors affecting stone-free rate following percutaneous nephrolithotomy.
Materials and Methods: We retrospectively analyzed the medical records of patients with renal stones who underwent PCNL in one tertiary hospital from January 2010 to June 2015. Patient’s demographics as well as stone composition were reviewed. Fisher’s exact test and logistic regression were applied for univariate analysis and multivariate analysis respectively in order to determine the factors affecting stone-free rate.
Results: A total of 515 procedures were performed for patients with renal stones. The Stone-free rate in our study was 50% (257/515). The mean patient age was 54.77±11.78 years. The mean operation time was 86.32±32.63 minutes and the mean length of hospital stay was 4.25±5.48 days. Using the univariate analysis, significant factors affecting stone-free rate were BMI≥27 (p=0.034), the number of calyx with stone involvement (p<0.001) and stone length ≥ 50mm (p<0.001). On multivariate logistic regression analysis, the number of calyx with stone involvement (OR=0.316, 95% CI:0.246-0.406, p<0.001) and stone length ≥ 50mm (OR=2.44, 95% CI:1.08-5.52, p=0.032) had a significant impact on the stone-free. However, gender, age, side of procedure, pre-operative hydronephrosis, access sheaths size (24F VS 30F), renal access by urologists or radiologists were not statistically significant factors.
Conclusions: Stone length ≥50mm and the number of calyx with stone involvement are the significant factors affecting stone free rate.