目的 分析经皮肾镜取石术(PCNL)术后胸膜损伤的发生情况及相关因素。方法 回顾性分析2023-02至2025-05在武警安徽总队医院泌尿外科行12肋上入路PCNL患者的临床资料。对患者的基本情况(性别、年龄、BMI、结石大小、病程长短、合并症)、手术情况(手术侧别、结石位置、穿刺盏、穿刺入路)及肋椎角(RVA)与胸膜损伤的关系进行评估。结果 本研究纳入78例行12肋上入路PCNL患者。患者的性别、年龄、BMI、结石大小、病程长短、合并症、手术侧别、结石位置和胸部损伤无关。14例发生胸膜损伤,分为胸膜损伤组,其中气胸8例、胸腔积液5例、血胸1例;64例未发生胸膜损伤,分为对照组。从构成比观察,穿刺部位在肾上盏的胸膜损伤高于肾中、下盏;穿刺入路选择在10肋间的胸膜损伤高于11肋间(5/9 vs 4/60),以上差异均有统计学意义(P<0.05);胸膜损伤组肋椎角(RVA)40°~45°的例数明显多于RVA 46°~50°和RVA>50°,对照组RVA 40°~45°的例数明显少于RVA 46°~50°和RVA>50°;组间比较时,RVA 40°~45°和RVA>50°的病例数构成比差异显著;胸膜损伤组平均RAV明显低于对照组[(44.32°±3.46°)vs.(52.17°±4.32°)],差异均有统计学意义。结论 肾上盏穿刺术中,穿刺位置越高、RVA越小,发生胸膜损伤的概率越大;RVA与胸膜损伤关系密切,可做为PCNL术后胸膜损伤发生的一个重要预测因素。
Abstract
Objective To analyze the incidence and related factors of pleural injuries after percutaneous nephrolithotomy (PCNL). Methods A retrospective analysis was conducted on clinical data of 78 patients who underwent PCNL via the 12th rib superior approach in the Department of Urology of Anhui Provincial Corps Hospital of Chinese People's Armed Police Force from February 2023 to May 2025. The basic information (gender, age, BMI, stone size, disease duration, and complications), surgical conditions (side of surgery, stone location, puncture calyx, puncture approach), and the relationship between the costoclavicular angle (VA) and pleural injury were evaluated. Results A total of 78 patients underwent PCNL via the 12th rib superior approach. There was no relationship between the gender, age, BMI, stone size, duration of illness, complications, side of surgery, stone location, and chest injuries among the patients. 14 patients developed pleural injuries, which were divided into a pleural injury group, including 8 cases of pneumothorax, 5 cases of pleural effusion, and 1 case of hemothorax, and 64 patients did not have pleural injuries, which were divided into a control group. The constituent ratio of pleural injuries was significantly higher when the puncture site was in the superior calyx than when it was in the middle and lower calyces; the constituent ratio of pleural injuries was higher in the 10th intercostal space than in the 11th intercostal space(5/9 vs. 4/60) , and the differences were statistically significant (P＜0.05); the number of cases with RVA 40°-45° in the pleural injury group was significantly higher than that with RVA46°-50° and RVA>50°, and the number cases with RVA 40°-45° in the control group was significantly lower than that with RVA46°-50° and RVA>50; when compared between groups, the percentage of cases with RVA40°-45° and RVA>50° was significantly different; the mean RVA in pleural injury group was significantly lower than that in the control group [(44.32°±3.46°) vs. (52.17°±4.32°)], and the differences were statistically significant. Conclusions The higher the puncture site in the superior calyx of the kidney and the smaller the RVA, the greater the chance of pleural injury; RVA is closely related to pleural injuries and can be used as an important predictive factor for the occurrence of pleural injuries after PCNL.
关键词
经皮肾镜取石术 /
胸膜损伤 /
胸腔积液 /
血胸 /
气胸 /
肋椎角
Key words
percutaneous nephrolithotomy /
pleural injury /
pleural effusion /
hemothorax /
pneumothorax /
rib-vertebral angle
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