超重/肥胖患者肾输尿管结石治疗的结果和分析

doi:10.3969/j.issn.1009-976X.2022.04.013

摘要/Abstract

摘要： 目的分析肥胖是否会影响肾结石治疗的效果及增加并发症的发生率。方法回顾性分析2018年3月至2022年4月间在我院接受外科治疗的肾或输尿管结石患者的临床数据,根据BMI水平将患者分为超重/肥胖组（≥24.0 kg/m²）和正常体重组,分别有98和212例入组。根据治疗的方法选择,比较超重/肥胖患者与正常体重患者接受体外冲击波碎石术（ESWL）、经皮肾镜取石术（PCNL）及输尿管软镜（FURS）碎石术下的临床结果和并发症。结果超重/肥胖组患者的BMI为27.6±1.9 kg/m²,其中,BMI≥28 kg/m²者29例,最高值为30.8 kg/m²。超重/肥胖患者应用ESWL显示较低的碎石成功率（68.5%）,和正常体重患者（72.7%）比较,两组的差异有统计学意义（P=0.0046）;由于超重/肥胖患者结石-皮肤距离（SSD）高于正常体重者（P<0.001）,在碎石过程中X线曝光时间也较正常体重明显延长（P=0.005）。PCNL的结石清除率在两组相当,差异没有统计学意义（P=0.118）,但超重/肥胖中PCNL的手术时间较正常体重患者明显延长（P=0.038）,前者Hb下降值也略高于后者,但差异没有统计学意义（P=0.069）。采用FURS的两组患者中,超重/肥胖组患者在结石残留、术后住院时间及并发症方面与正常体重组患者相当。结论本组病例中,肾输尿管结石肥胖患者可同正常体重患者一样选择各种清除结石的治疗方法,两组临床效果相当,但ESWL的成功率略低,肥胖患者选择ESWL应建立在更加综合分析的基础上。另外,超重/肥胖组可能伴随治疗费用以及并发症增加的风险。

关键词: 肥胖, 肾输尿管结石, 外科治疗

Abstract: Objective To investigate whether obesity affects the efficacy of kidney stone treatment and increases the incidence of complications. Methods The clinical data of patients with kidney or ureteral stones who were treated with extracorporeal shock wave lithotripsy （ESWL）, percutaneous nephrolithotomy （PCNL）, or flexible ureteroscopic （FURS） from March 2018 to April 2022 were retrospectively analyzed, and the patients were divided into overweight/obesity group and normal weightgroup according to Body Mass Index （BMI）, with 98 in the overweight/obesity group（BMI≥24.0 kg/m²） and 212 in the normal weigh group, respectively. The clinical outcomes and complications were compared between two groups when patients underwent ESWL, PCNL, or FURS lithotripsy. Results The BMI of patients in the overweight/obese group was 27.6±1.9 kg/m², of which 29 patients had BMI ≥28 kg/m², and the highest was 30.8 kg/m². The performance of ESWL in overweight/obese patients showed a lower success rate of lithotripsy （68.5%）, and compared with normal weight patients （72.7%）, the difference between the two groups was statistically significant （P=0.0046）; due to the high Skin-to-Stone Distance （SSD） in overweight/obese patients were higher than that of normal weight patients （P<0.001）, the X-ray exposure time during lithotripsy was also significantly longer than that of normal weight patients （P=0.005）. The stone-free rate of PCNL was comparable between the two groups, and the difference was not statistically significant （P=0.118）. However, in overweight/obese patients, the operation time of PCNL was significantly longer in overweight/obese patients than in normal-weight patients （P=0.038）, and the former showed a decrease of Hb slightly, but the difference was not statistically significant （P=0.069）. In the two groups of patients treated with FURS, the overweight/obese group was comparable to the normal weight group in terms of residual stone, postoperative hospital stay, and complications. Conclusion The obese patients with kidney or ureteral stones can choose various treatment methods to remove stones like normal-weight patients. The clinical effects of the two groups are similar, but the success rate of ESWL is slightly lower. The choice of ESWL in obese patients should be based on a more information. In addition, the overweight/obese group may be at increased risk of associated treatment costs and complications.

Key words: obese, kidneyor ureteral stones, surgery

中图分类号:

R693+.4

徐凯, 林渊, 朱国树. 超重/肥胖患者肾输尿管结石治疗的结果和分析[J]. 岭南现代临床外科, 2022, 22(04): 384-388.

XU Kai, LIN Yuan, ZHU Guo-shu. Outcomes and analysis on treatment of ureteral and kidney stones in patients with overweight and obesity[J]. Lingnan Modern Clinics In Surgery, 2022, 22(04): 384-388.

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