| Objctive: By collecting the perioperative data of patients with single upper calyx calculi treated with non-same calyceal puncture PCNL,this study aims to study the factors affecting the residual stones after PCNL,and expects to provide a scientific theoretical basis for improving the safety of operation and reducing the rate of postoperative residual stones.Methods: A retrospective clinical study was conducted to collect the clinical data of115 patients with single upper calyx calculi treated by PCNL in the Department of Urology of the first affiliated Hospital of Dali University from March 2016 to September 2020.Including general conditions(sex,age,side of calculi,preoperative renal function,preoperative hydronephrosis,current history,past history and underlying diseases),operation and stone data(stone surface area,renal calyceal puncture,stone density,renal calyx neck length,renal calyx neck width,non-same calyceal puncture angle).According to the routine reexamination of KUB or NCCT 2-3 days after operation(If the stone is negative before operation,the NCCT should be reexamined),the collected cases were divided into residual stone group(n = 41)and clean stone group(n = 74)(No residual stone or residual stone < 4mm was considered as clean stone group,and postoperative residual stone ≥ 4mm was regarded as residual stone group).The above-mentioned indexes that may affect the residual stone rate after nonsame-calyceal puncture PCNL were analyzed by SPSS 20.0 statistical software.First,the relevant indexes that may affect the residual stone rate after non-same-calyceal puncture PCNL were analyzed by univariate analysis,and then the statistically significant indexes were analyzed by multi-factor Logistic binary regression analysis,P< 0.05 was regarded as the difference was statistically significant.Results:In this study,the rate of residual stone after non-identical puncture PCNL was35.7%(41/115),Clean stone rate was 64.3%(74/115).Univariate analysis showed that sex,age,stone side,BMI,preoperative hydronephrosis,renal calyx puncture,stone density and calyx neck width were not significantly correlated with residual stone rate after PCNL(P>0.05);However,the renal function before operation,the surface area of calculi,the length of renal calyceal neck and the angle of non-identical calyceal puncture were significantly correlated with the rate of residual stone after non-identical calyceal puncture PCNL(P<0.05).The indexes with correlation by single factor analysis were analyzed by multi-factor Logistic binary regression analysis,The results showed that there was no significant correlation between preoperative renal function and residual stone rate after PCNL different calyceal puncture(P>0.05);And the surface area of stone(P=0.001,OR=1.067,OR 的 95%CI:1.025-1.110)、the length of renal calyceal neck where the stones are located(P=0.000,OR=4.997,OR 的95%CI:2.090-11.951)、the angle between different calyceal puncture(P=0.030,OR=0.937,OR 的 95%CI:0.883-0.994)are the independent risk factors for residual stones after PCNL with different calyceal puncture.Conclusion: 1.Sex,age,stone side,hydronephrosis before BMI,renal calyx puncture,stone density and calyceal neck width are not the influencing factors of residual stones after PCNL;2.Preoperative renal function,stone surface area,renal calyceal neck length and non-identical calyceal puncture angle are the influencing factors of residual stones after non-identical calyceal puncture PCNL,and stone surface area,renal calyceal neck length and non-identical calyceal puncture angle are independent risk factors affecting stone clearance after non-identical calyceal puncture PCNL;3.defining the structural characteristics of renal collecting system before operation,evaluating stone load and actively improving patients’ renal function are the key to accurate puncture during operation and to improve the rate of stone clearance after operation. |
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