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

doi:10.12122/j.issn.1673-4254.2025.09.08

摘要/Abstract

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

刘炎忠, 朱润, 李玉柱, 马鑫, 麦海星. 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[J]. 南方医科大学学报, 2025, 45(9): 1880-1888.

Yanzhong LIU, Run ZHU, Yuzhu LI, Xin MA, Haixing MAI. Intraoperative renal collecting system damage increases risks of ipsilateral upper urinary tract stones after partial nephrectomy: a 1∶2 propensity-matched case-control study[J]. Journal of Southern Medical University, 2025, 45(9): 1880-1888.

图/表 10

图1 研究路线图

Fig.1 Flow chart of the study.

图2 倾向性评分匹配图

Fig.2 Plot of the propensity score-matched study. A: Dot plot of standardized mean difference. B: Histogram of standardized mean differences (before and after).

图3 肾部分切除术后同侧及对侧上尿路结石发病情况、临床特征及治疗

Fig.3 Incidence, clinical features and treatment of ipsilateral and contralateral stones after partial nephrectomy. A: Number of new and accumulated patients with ipsilateral and contralateral upper urinary tract stones. B: Difference of maximum diameter between ipsilateral and contralateral upper urinary tract stones after operation. C: The treatment difference of ipsilateral and contralateral upper urinary tract stones after operation.

表1 肾部分切除术后继发上尿路结石患者的一般资料

Tab.1 Clinical characteristics of patients with upper urinary tract stones after partial nephrectomy

Clinical characteristics	Patients with unilateral stones				Patients with bilateral stones
Clinical characteristics	Surgical side (n=71)	Non-surgical side (n=21)	T/ $χ 2$ /Z	P	Surgical side (n=20)	Non-surgical side (n=20)	T/ $χ 2$ /Z	P
Age (years, Mean±SD)	50.18±10.77	46.43±10.05	1.424^a	0.158	45.75±12.11	45.75±12.11
BMI (Mean±SD)	27.00±3.68	26.2±3.50	0.891^a	0.375	26.17±4.57	26.17±4.57
Gender [n (%)]			1.840^b	0.205
Male	60 (84.51)	15 (71.43)			16 (80.00)	16 (80.00)
Female	11 (15.49)	6 (28.57)			4 (20.00)	4 (20.00)
Maximum diameter (mm)	3 (2-18)	3 (2-8)	-2.140^c	0.032	2 (2-20)	2.5 (2-19)	1.296^c	0.195
Maximum diameter >6 mm [n (%)]			7.411^b	0.005			0.784^b	0.661
Yes	25 (35.21)	1 (4.76)			2 (10.00)	4 (20.00)
No	46 (64.79)	20 (95.24)			18 (90.00)	16 (80.00)
Surgical treatment [n (%)]			6.418^b	0.011			0.229^b	1.000
Yes	23 (32.39)	1 (4.76)			2 (10.00)	3 (15.00)
No	48 (67.61)	20 (95.24)			18 (80.00)	17 (85.00)

表1 肾部分切除术后继发上尿路结石患者的一般资料

Tab.1 Clinical characteristics of patients with upper urinary tract stones after partial nephrectomy

Clinical characteristics	Patients with unilateral stones				Patients with bilateral stones
Clinical characteristics	Surgical side (n=71)	Non-surgical side (n=21)	T/ $χ 2$ /Z	P	Surgical side (n=20)	Non-surgical side (n=20)	T/ $χ 2$ /Z	P
Age (years, Mean±SD)	50.18±10.77	46.43±10.05	1.424^a	0.158	45.75±12.11	45.75±12.11
BMI (Mean±SD)	27.00±3.68	26.2±3.50	0.891^a	0.375	26.17±4.57	26.17±4.57
Gender [n (%)]			1.840^b	0.205
Male	60 (84.51)	15 (71.43)			16 (80.00)	16 (80.00)
Female	11 (15.49)	6 (28.57)			4 (20.00)	4 (20.00)
Maximum diameter (mm)	3 (2-18)	3 (2-8)	-2.140^c	0.032	2 (2-20)	2.5 (2-19)	1.296^c	0.195
Maximum diameter >6 mm [n (%)]			7.411^b	0.005			0.784^b	0.661
Yes	25 (35.21)	1 (4.76)			2 (10.00)	4 (20.00)
No	46 (64.79)	20 (95.24)			18 (90.00)	16 (80.00)
Surgical treatment [n (%)]			6.418^b	0.011			0.229^b	1.000
Yes	23 (32.39)	1 (4.76)			2 (10.00)	3 (15.00)
No	48 (67.61)	20 (95.24)			18 (80.00)	17 (85.00)

表2 匹配前后患者年龄、性别和BMI差异性分析

Tab.2 Analysis of the differences in age, gender and BMI of the patients before and after matching

Item	Before matched					After matched
Item	Total (n=1394)	Control group (n=1323)	Case group (n=71)	t/ $χ 2$	P	Total (n=207)	Control group (n=138)	Case group (n=69)	t/ $χ 2$	P
Age (year)	52.13±11.41	52.23±11.44	50.18±10.77	1.474	0.141	49.86±11.49	49.54±11.88	50.49±10.74	-0.559	0.577
BMI	25.95±3.43	25.89±3.41	27.01±3.68	-2.679	0.007	26.51±3.39	26.40±3.46	26.72±3.27	-0.635	0.526
Gender				5.502	0.019				0.076	0.783
Male	1009(72.38)	949 (71.73)	60 (84.51)			176 (85.02)	118 (85.51)	58 (84.06)
Female	385 (27.62)	374 (28.27)	11 (15.49)			31 (14.98)	20 (14.49)	11 (15.94)

表2 匹配前后患者年龄、性别和BMI差异性分析

Tab.2 Analysis of the differences in age, gender and BMI of the patients before and after matching

Item	Before matched					After matched
Item	Total (n=1394)	Control group (n=1323)	Case group (n=71)	t/ $χ 2$	P	Total (n=207)	Control group (n=138)	Case group (n=69)	t/ $χ 2$	P
Age (year)	52.13±11.41	52.23±11.44	50.18±10.77	1.474	0.141	49.86±11.49	49.54±11.88	50.49±10.74	-0.559	0.577
BMI	25.95±3.43	25.89±3.41	27.01±3.68	-2.679	0.007	26.51±3.39	26.40±3.46	26.72±3.27	-0.635	0.526
Gender				5.502	0.019				0.076	0.783
Male	1009(72.38)	949 (71.73)	60 (84.51)			176 (85.02)	118 (85.51)	58 (84.06)
Female	385 (27.62)	374 (28.27)	11 (15.49)			31 (14.98)	20 (14.49)	11 (15.94)

表3 匹配后肾部分切除术后患者一般资料及围手术期情况

Tab.3 General and perioperative data of the patientsafter partial nephrectomy (after propensity score matching)

Variable		Control group after matching (n=138)	Case group after matching (n=69)	T/ $χ 2$ /Z	P
Tumor size (cm)		2.93±1.10	2.72±1.04	1.296^a	0.196
Multiple tumors	Yes	1 (0.72)	1 (1.45)	0.252^b	0.615
Multiple tumors	No	137 (99.28)	68 (98.55)	0.252^b	0.615
Operation time (min)		130.00 (95.75, 155.00)	120.00 (91.50, 148.50)	-1.110^c	0.267
Tumor location	Left	67 (48.55)	40 (57.97)	1.635^b	0.201
Tumor location	Right	71 (51.45)	29 (42.03)	1.635^b	0.201
Tumor hemorrhage	Yes	71 (51.45)	26 (37.68)	3.502^b	0.061
Tumor hemorrhage	No	67 (48.55)	43 (62.32)	3.502^b	0.061
Tumor cystic change	Yes	47 (34.06)	21 (30.43)	0.274^b	0.601
Tumor cystic change	No	91 (65.94)	48 (69.57)	0.274^b	0.601
Tumor necrosis	Yes	9 (6.52)	4 (5.80)	0.041^b	0.839
Tumor necrosis	No	129 (93.48)	65 (94.20)	0.041^b	0.839
Diabetes	Yes	15 (10.87)	12 (17.39)	1.725^b	0.189
Diabetes	No	123 (89.13)	57 (82.61)	1.725^b	0.189
Ardiovascular diseases	Yes	9 (6.52)	2 (2.90)	1.200^b	0.273
Ardiovascular diseases	No	129 (93.48)	67 (97.10)	1.200^b	0.273
Hypertension	Yes	39 (28.26)	16 (23.19)	0.607^b	0.436
Hypertension	No	99 (71.74)	53 (76.81)	0.607^b	0.436
Smoke	Yes	21 (15.22)	11 (15.94)	0.018^b	0.892
Smoke	No	117 (84.78)	58 (84.06)	0.018^b	0.892
Drink	Yes	22 (15.94)	7 (10.14)	1.283^b	0.257
Drink	No	116 (84.06)	62 (89.86)	1.283^b	0.257
Hematuria	Yes	5 (3.62)	3 (4.35)	0.065^b	0.799
Hematuria	No	133 (96.38)	66 (95.65)	0.065^b	0.799
Endogenous tumor	Yes	86 (62.77)	40 (57.97)	0.446^b	0.504
Endogenous tumor	No	51 (37.23)	29 (42.03)	0.446^b	0.504
RPCI	Yes	58 (42.34)	52 (75.36)	20.110^b	<0.001
RPCI	No	79 (57.66)	17 (24.64)	20.110^b	<0.001
Hyperlipidemia	Yes	48 (34.78)	23 (33.33)	0.043^b	0.836
Hyperlipidemia	No	90 (65.22)	46 (66.67)	0.043^b	0.836
Hyperuricemia	Yes	22 (15.94)	13 (18.84)	0.275^b	0.600
Hyperuricemia	No	116 (84.06)	56 (81.16)	0.275^b	0.600
Surgical method	Robot-assisted	66 (47.83)	30 (43.48)	0.350^b	0.554
Surgical method	Laparoscopy	72 (52.17)	39 (56.52)	0.350^b	0.554
Estimated intraoperative blood loss (mL)		50.00 (20.00, 80.00)	50.00 (20.00, 50.00)	-0.284^c	0.776
Renal ischemia-reperfusion time (min)		19.90±7.42	20.03±7.67	-0.116^a	0.908
Glomerular filtration rate (mL/min)		103.78±8.69	102.58±7.45	1.032^a	0.304

表3 匹配后肾部分切除术后患者一般资料及围手术期情况

Tab.3 General and perioperative data of the patientsafter partial nephrectomy (after propensity score matching)

Variable		Control group after matching (n=138)	Case group after matching (n=69)	T/ $χ 2$ /Z	P
Tumor size (cm)		2.93±1.10	2.72±1.04	1.296^a	0.196
Multiple tumors	Yes	1 (0.72)	1 (1.45)	0.252^b	0.615
Multiple tumors	No	137 (99.28)	68 (98.55)	0.252^b	0.615
Operation time (min)		130.00 (95.75, 155.00)	120.00 (91.50, 148.50)	-1.110^c	0.267
Tumor location	Left	67 (48.55)	40 (57.97)	1.635^b	0.201
Tumor location	Right	71 (51.45)	29 (42.03)	1.635^b	0.201
Tumor hemorrhage	Yes	71 (51.45)	26 (37.68)	3.502^b	0.061
Tumor hemorrhage	No	67 (48.55)	43 (62.32)	3.502^b	0.061
Tumor cystic change	Yes	47 (34.06)	21 (30.43)	0.274^b	0.601
Tumor cystic change	No	91 (65.94)	48 (69.57)	0.274^b	0.601
Tumor necrosis	Yes	9 (6.52)	4 (5.80)	0.041^b	0.839
Tumor necrosis	No	129 (93.48)	65 (94.20)	0.041^b	0.839
Diabetes	Yes	15 (10.87)	12 (17.39)	1.725^b	0.189
Diabetes	No	123 (89.13)	57 (82.61)	1.725^b	0.189
Ardiovascular diseases	Yes	9 (6.52)	2 (2.90)	1.200^b	0.273
Ardiovascular diseases	No	129 (93.48)	67 (97.10)	1.200^b	0.273
Hypertension	Yes	39 (28.26)	16 (23.19)	0.607^b	0.436
Hypertension	No	99 (71.74)	53 (76.81)	0.607^b	0.436
Smoke	Yes	21 (15.22)	11 (15.94)	0.018^b	0.892
Smoke	No	117 (84.78)	58 (84.06)	0.018^b	0.892
Drink	Yes	22 (15.94)	7 (10.14)	1.283^b	0.257
Drink	No	116 (84.06)	62 (89.86)	1.283^b	0.257
Hematuria	Yes	5 (3.62)	3 (4.35)	0.065^b	0.799
Hematuria	No	133 (96.38)	66 (95.65)	0.065^b	0.799
Endogenous tumor	Yes	86 (62.77)	40 (57.97)	0.446^b	0.504
Endogenous tumor	No	51 (37.23)	29 (42.03)	0.446^b	0.504
RPCI	Yes	58 (42.34)	52 (75.36)	20.110^b	<0.001
RPCI	No	79 (57.66)	17 (24.64)	20.110^b	<0.001
Hyperlipidemia	Yes	48 (34.78)	23 (33.33)	0.043^b	0.836
Hyperlipidemia	No	90 (65.22)	46 (66.67)	0.043^b	0.836
Hyperuricemia	Yes	22 (15.94)	13 (18.84)	0.275^b	0.600
Hyperuricemia	No	116 (84.06)	56 (81.16)	0.275^b	0.600
Surgical method	Robot-assisted	66 (47.83)	30 (43.48)	0.350^b	0.554
Surgical method	Laparoscopy	72 (52.17)	39 (56.52)	0.350^b	0.554
Estimated intraoperative blood loss (mL)		50.00 (20.00, 80.00)	50.00 (20.00, 50.00)	-0.284^c	0.776
Renal ischemia-reperfusion time (min)		19.90±7.42	20.03±7.67	-0.116^a	0.908
Glomerular filtration rate (mL/min)		103.78±8.69	102.58±7.45	1.032^a	0.304

表4 匹配后肾部分切除术患者继发同侧上尿路结石的条件回归分析

Tab.4 Conditional regression analyses of secondary operative renal ureteral calculi in patients after partial nephrectomy (after propensity score matching)

Variable	Univariate analysis			Multivariate analysis
Variable	P	OR	95% CI	P	OR	95% CI
Tumor size (cm)	0.182	0.821	0.615-1.096
Multiple tumors	0.624	2.000	0.125-31.975
Operation time (min)	0.222	0.996	0.989-1.003
Tumor location	0.182	0.66	0.358-1.215
Tumor hemorrhage	0.072	0.584	0.325-1.050	0.160	0.629	0.329-1.201
Tumor cystic change	0.586	0.835	0.436-1.599
Tumor necrosis	0.845	0.889	0.274-2.886
Diabetes	0.208	1.669	0.753-3.700	0.057	2.419	0.973-6.012
Ardiovascular diseases	0.277	0.415	0.085-2.025
Hypertension	0.429	0.76	0.385-1.501
Smokeing	0.894	1.055	0.483-2.303
Drinking	0.289	0.627	0.264-1.487
Hematuria	0.803	1.2	0.287-5.021
Endogenous tumor	0.523	0.816	0.438-1.522
RPCI	<0.001	4.103	2.110-7.978	<0.001	4.550	2.237-9.252
Hyperlipidemia	0.819	0.924	0.470-1.815	0.964	0.982	0.444-2.173
Hyperuricemia	0.580	1.257	0.559-2.825	0.493	1.398	0.536-3.650
Surgical method	0.545	1.203	0.661-2.190
Estimated intraoperative blood loss (mL)	0.544	0.999	0.996-1.002
Renal ischemia-reperfusion time (min)	0.907	1.002	0.964-1.042
Glomerular filtration rate (mL/min)	0.333	0.983	0.948-1.018

表5 肿瘤大小亚组分析

Tab.5 Subgroup analysis of tumor size

Variable	Tumor size≤3 cm			Tumor size>3 cm
Variable	P	OR	95% CI	P	OR	95% CI
Tumor hemorrhage	0.215	0.612	0.282-1.330	0.373	0.590	0.184-1.885
Diabetes	0.014	3.820	1.317-11.078	0.173	0.204	0.021-2.010
Hyperlipidemia	0.988	1.007	0.420-2.411	0.776	1.192	0.356-3.985
Hyperuricemia	0.294	1.837	0.590-5.718	0.827	1.165	0.296-4.580
RPCI	0.001	4.001	1.761-9.091	0.001	9.913	2.440-40.279

表6 肿瘤内生生长亚组分析

Tab.6 Subgroup analysis of endogenous tumor growth

Variable	Endogenous tumor			Tumor outreach
Variable	P	OR	95% CI	P	OR	95% CI
Tumor hemorrhage	0.069	0.469	0.208-1.061	0.813	0.880	0.306-2.535
Diabetes	0.332	1.731	0.572-5.241	0.129	3.430	0.699-16.825
Hyperlipidemia	0.630	1.239	0.519-2.958	0.994	1.004	0.295-3.421
Hyperuricemia	0.773	1.174	0.395-3.492	0.453	1.735	0.412-7.313
RPCI	0.005	3.747	1.478-9.501	<0.001	8.718	2.883-26.362

表7 手术方式亚组分析

Tab.7 Subgroup analysis of surgical approaches

Variable	Robot-assisted			Laparoscopy
Variable	P	OR	95% CI	P	OR	95% CI
Tumor hemorrhage	0.720	0.842	0.330-2.150	0.147	0.396	0.159-1.089
Diabetes	0.067	3.616	0.914-14.315	0.704	1.273	0.365-4.438
Hyperlipidemia	0.390	1.578	0.558-4.463	0.310	0.602	0.227-1.601
Hyperuricemia	0.267	1.919	0.608-6.061	0.756	1.235	0.327-4.655
RPCI	0.012	3.784	1.348-10.622	0.000	5.604	2.254-13.932

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