南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (9): 1880-1888.doi: 10.12122/j.issn.1673-4254.2025.09.08

• • 上一篇    

术中肾脏集合系统受损是肾部分切除术后同侧上尿路结石发病的危险因素:一项1∶2匹配病例对照研究

刘炎忠1,2, 朱润2, 李玉柱2, 马鑫2(), 麦海星2()   

  1. 1.解放军医学院,北京 100083
    2.解放军总医院第三医学中心泌尿外科医学部,北京 100039
  • 收稿日期:2025-02-12 出版日期:2025-09-20 发布日期:2025-09-28
  • 通讯作者: 马鑫,麦海星 E-mail:urologist@foxmail.com;maihx1981@163.com
  • 作者简介:刘炎忠,在读博士研究生,主治医师,E-mail: 15001168010 @163.com
  • 基金资助:
    解放军总医院青年自主创新科学基金(22QNFC045);中国人民解放军总医院第三医学中心学科创新发展专项(2024BJ-13)

Intraoperative renal collecting system damage increases risks of ipsilateral upper urinary tract stones after partial nephrectomy: a 12 propensity-matched case-control study

Yanzhong LIU1,2, Run ZHU2, Yuzhu LI2, Xin MA2(), Haixing MAI2()   

  1. 1.Medical School of Chinese PLA, Beijing 100083, China
    2.Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing 100039, China
  • Received:2025-02-12 Online:2025-09-20 Published:2025-09-28
  • Contact: Xin MA, Haixing MAI E-mail:urologist@foxmail.com;maihx1981@163.com

摘要:

目的 探讨肾部分切除术后继发同侧上尿路结石的发病情况及其危险因素。 方法 回顾性分析我中心行肾部分切除术的患者基线资料(年龄、性别、体质量指数),生活习惯(吸烟、饮酒),基础病(高血压、糖尿病、高甘油三酯血症、高胆固醇血症、高尿酸血症、心血管疾病),肾肿瘤术前情况(肿瘤最大直径、肿瘤多发、肿瘤位置、肿瘤伴有出血、肿瘤伴有坏死、肿瘤伴有囊性变、肿瘤生长方式),术前肾小球滤过率、术中情况(肾脏集合系统受损、肾脏缺血时间、手术时间、手术方式、术中预计出血量)。分析肾部分切除术后继发同侧上尿路结石的临床特征及危险因素。 结果 肾部分切除术后上尿路结石发病率为7.80%(112/1435),其中同侧上尿路结石发病率高于对侧上尿路结石发病率(4.95% vs 1.46%,P<0.001)。同侧上尿路结石发病率高于双侧上尿路结石发病率(4.95% vs 1.39%,P<0.001)。术中肾脏集合系统受损是肾部分切除术后继发同侧上尿路结石的危险因素(OR=4.550,95% CI:2.237~9.252,P<0.001);糖尿病可能是肾部分切除术后继发同侧上尿路结石的危险因素(OR=2.419,95% CI:0.973~6.012,P=0.057)。 结论 肾部分切除术后同侧上尿路结石发病率高于对侧及双侧。术中肾脏集合系统是肾部分切除术后继发同侧上尿路结石的危险因素。

关键词: 肾部分切除术, 尿石症, 肾脏集合系统

Abstract:

Objective To investigate the incidence of ipsilateral upper urinary tract stones after partial nephrectomy and its risk factors. Methods We retrospectively analyzed baseline patient characteristics (age, gender, and body mass index), smoking, alcohol consumption, comorbidities (hypertension, diabetes, hypertriglyceridemia, hyperuricemia, and cardiovascular diseases), preoperative tumor conditions (tumor diameter, multiple foci, location, hemorrhage, necrosis, cystic changes, and endophytic growth), preoperative glomerular filtration rate and intraoperative factors (renal collecting system damage, ischemia time, operation time, surgical approach, and estimated intraoperative blood loss) to identify the risk factors for ipsilateral upper urinary tract stones following partial nephrectomy in our center. Results The overall incidence of upper urinary tract stones following partial nephrectomy was 7.80% (112/1435). The incidence of ipsilateral upper urinary tract stones was significantly higher than those of contralateral stones (4.95% vs 1.46%, P<0.001) and bilateral stones (4.95% vs 1.39%, P<0.001). Intraoperative damage to the renal collecting system was identified as a significant risk factor for ipsilateral upper urinary tract stones (OR=4.550, 95% CI: 2.237-9.252, P<0.001). Diabetes was a probable risk factor for secondary ipsilateral upper urinary tract stones after partial nephrectomy (OR=2.419, 95% CI: 0.973-6.012, P=0.057). Conclusions The incidence of ipsilateral upper urinary tract stones after partial nephrectomy is higher than that of contralateral and bilateral stones. Intraoperative renal collecting system damage is a risk factor for secondary ipsilateral upper urinary tract stones after partial nephrectomy.

Key words: partial nephrectomy, urolithiasis, renal collecting system