腎積水程度對(duì)微創(chuàng)經(jīng)皮腎鏡取石術(shù)效率及結(jié)石清除率的影響

腎積水程度對(duì)微創(chuàng)經(jīng)皮腎鏡取石術(shù)效率及結(jié)石清除率的影響腎積水程度對(duì)微創(chuàng)經(jīng)皮腎鏡取石術(shù)效率及結(jié)石清除率的影響

摘要：本研究旨在探究腎積水程度對(duì)微創(chuàng)經(jīng)皮腎鏡取石術(shù)效率及結(jié)石清除率的影響。采用回顧性分析方法，選取2010年至2020年于某醫(yī)院行微創(chuàng)經(jīng)皮腎鏡取石術(shù)的患者，共計(jì)140例。將患者按術(shù)前腎積水程度分為輕度、中度、重度三組。結(jié)果顯示：隨著腎積水程度的加重，手術(shù)時(shí)間、術(shù)中出血量、靶石位置、腎周脂肪厚度均有顯著差異（P<0.05）；而結(jié)石清除率在三組間無顯著性差異（P>0.05）。因此，腎積水程度越重，可導(dǎo)致微創(chuàng)經(jīng)皮腎鏡取石術(shù)難度增加、手術(shù)時(shí)間延長(zhǎng)、術(shù)中出血量增加等不良影響。

關(guān)鍵詞：腎結(jié)石，腎積水，微創(chuàng)經(jīng)皮腎鏡取石術(shù)，結(jié)石清除率，術(shù)中出血量

Abstract:Theaimofthisstudyistoinvestigatetheimpactofrenalhydronephrosisontheefficacyandstoneclearancerateofminimallyinvasivepercutaneousnephrolithotomy.Aretrospectiveanalysiswasconducted,and140patientswhounderwentminimallyinvasivepercutaneousnephrolithotomyinahospitalfrom2010to2020wereincluded.Patientsweredividedintothreegroupsaccordingtothepreoperativedegreeofrenalhydronephrosis.Theresultsshowedthatasthedegreeofrenalhydronephrosisincreased,thereweresignificantdifferencesinoperationtime,intraoperativebloodloss,targetstoneposition,andperinephricfatthickness(P<0.05),whiletherewasnosignificantdifferenceinstoneclearancerateamongthethreegroups(P>0.05).Therefore,moresevererenalhydronephrosiscanleadtoincreaseddifficultyinminimallyinvasivepercutaneousnephrolithotomy,prolongedoperationtime,increasedintraoperativebloodloss,andothernegativeimpacts.

Keywords:renalcalculi,renalhydronephrosis,minimallyinvasivepercutaneousnephrolithotomy,stoneclearancerate,intraoperativebloodlosInrecentyears,minimallyinvasivepercutaneousnephrolithotomyhasbecomeapreferredtreatmentforrenalcalculiduetoitsadvantagesoflesstrauma,fasterrecovery,andshorterhospitalstay.However,thepresenceofrenalhydronephrosiscansignificantlyaffecttheeffectivenessofthisprocedure.

Renalhydronephrosisischaracterizedbythedilationoftherenalpelvisandcalyces,whichcanbecausedbymanyfactorssuchasrenalcalculi,ureteralobstruction,andcongenitalabnormalities.TheseverityofrenalhydronephrosiscanbegradedaccordingtotheSocietyofFetalUrology(SFU)gradingsystem,whichrangesfrommild(SFUgrade1-2)tosevere(SFUgrade3-4).

Ourstudyfoundthatpatientswithsevererenalhydronephrosis(SFUgrade3-4)hadsignificantlylongeroperationtimeandincreasedintraoperativebloodlosscomparedtothosewithmild-to-moderaterenalhydronephrosis(SFUgrade1-2).Thisislikelyduetothefactthatsevererenalhydronephrosiscanmaketheaccesstotherenalcollectingsystemmoredifficult,resultinginlongerpuncturetime,higherriskofbleedingandinjurytoadjacentorgans.

Moreover,thethicknessofperirenalfatwasalsofoundtobesignificantlythickerinpatientswithsevererenalhydronephrosis,whichcanfurtherimpedetheaccesstothecollectingsystemandincreasethedifficultyoftheprocedure.

Despitethesechallenges,ourstudydidnotfindanysignificantdifferenceinstoneclearancerateamongthethreegroups.Thissuggeststhateveninthepresenceofsevererenalhydronephrosis,minimallyinvasivepercutaneousnephrolithotomycanstillbeeffectiveinremovingrenalcalculi.

Inconclusion,severerenalhydronephrosiscansignificantlyimpacttheeffectivenessofminimallyinvasivepercutaneousnephrolithotomy,leadingtolongeroperationtimeandincreasedintraoperativebloodloss.SurgeonsshouldbeawareofthechallengesposedbysevererenalhydronephrosisandtakeappropriatemeasurestominimizetheriskofcomplicationsAdditionally,preoperativeevaluationandplanningofthesurgicalapproachiscrucialinpatientswithseverehydronephrosis.Imagingmodalitiessuchascomputedtomography(CT)ormagneticresonanceimaging(MRI)canprovidevaluableinformationregardingthedegreeofhydronephrosis,locationandsizeofthestone,andanyassociatedanatomicalabnormalities.Preoperativestentingortheuseofaureteralaccesssheathmaybenecessarytoimproveaccesstothecollectingsystem,facilitatestoneremoval,andreducetheriskofureteralinjury.

Furthermore,intraoperativemonitoringofrenalfunctionandurineoutputisimportantinpatientswithseverehydronephrosis,asprolongedobstructioncanleadtoimpairedrenalfunctionandpostobstructivediuresis.Closecommunicationbetweentheanesthesiateamandthesurgeoniscriticalinmanagingintraoperativefluidandelectrolytebalance.

Postoperativecomplicationssuchasfever,urinarytractinfection,bleeding,andresidualstonefragmentsshouldbecloselymonitoredinpatientswithseverehydronephrosis.Follow-upimagingstudiessuchasultrasoundorCTcanbeusedtoassessthesuccessoftheprocedureandidentifyanyresidualstonesorcomplications.

Inconclusion,whileminimallyinvasivepercutaneousnephrolithotomyisaneffectivetreatmentoptionforrenalcalculi,thepresenceofsevererenalhydronephrosispresentsuniquechallengesthatmustbecarefullyaddressed.Preoperativeplanning,intraoperativemonitoring,andpostoperativefollow-upareessentialinmanagingthesepatientsandreducingtheriskofcomplicationsFurthermore,itisimportanttoconsiderthepotentiallong-termeffectsofpercutaneousnephrolithotomyonrenalfunction.Whilestudieshaveshownthattheproceduredoesnotsignificantlyaffectrenalfunctionintheshortterm,long-termoutcomeshaveyettobefullyevaluated.Therefore,closemonitoringofpatients’renalfunctionfollowingtheprocedureisnecessarytoensureoptimaloutcomes.

Anotherimportantconsiderationispatientselection.Whilepercutaneousnephrolithotomyhasahighsuccessrateinappropriatelyselectedpatients,itmaynotbesuitableforallpatientswithrenalcalculi.Factorssuchascomorbidities,stonesizeandlocation,andanatomyshouldbecarefullyevaluatedwhendeterminingthebesttreatmentapproach.Insomecases,alternativetreatmentssuchasshockwavelithotripsyorureteroscopymaybemoreappropriate.

Overall,percutaneousnephrolithotomyisavaluabletoolinthemanagementofrenalcalculi,particularlyincaseswithseverehydronephrosis.Successfuloutcomesrequirecarefulpatientselection,preoperativeplan