输尿管壁厚度对体外冲击波碎石效果预测价值的初步研究-现代医学

输尿管壁厚度对体外冲击波碎石效果预测价值的初步研究

单位：首都医科大学电力教学医院泌尿外科, 北京 100073

分类号：R693.4

出版年·卷·期（页码）：2021·49·第二期（153-157）

摘要：

目的：探讨输尿管壁厚度（UWT）对体外冲击波碎石（ESWL）术后结石清除率的预测价值。方法：选取我院2018年1月—2019年12月诊断为输尿管结石并行ESWL术治疗的患者为研究对象。按照ESWL术后碎石效果分为碎石清除组和结石残留组。比较两组患者术前临床资料和术后并发症发生率。多因素Logistics回归分析影响碎石效果的预测因子，采用受试者工作特征（ROC）曲线评估其精确性及截点值。结果：所有患者ESWL术后结石清除率为74.83%（113/151）。两组患者在年龄、疼痛视觉模拟评分（VAS）、结石病程、结石CT值及UWT，差异具有统计学意义（P<0.05），而在性别、体重指数（BMI）、结石大小、位置等方面差异均无统计学意义（P>0.05）。多因素Logistic回归分析结石CT值及UWT可作为预测ESWL术后碎石效果的独立预测因子。ROC曲线比较ESWL术碎石效果的预测因子，UWT曲线下面积（AUC）最大（AUC=0.918，P<0.05），UWT最佳预测值为3.05 mm。低UWT组在ESWL术后非预期急诊手术低于高UWT组，差异具有统计学意义（P<0.05）。结论：结石CT值、UWT对ESWL术后结石清除率的独立预测因子，UWT对ESWL术碎石效果有较好的预测价值。

Objective:To explore the predictive value of uretheral wall thickness for stone-free rate after extracorporeal shockwave lithotripsy(ESWL).Methods: Patients who diagnosed as uretheral calculi and treated with ESWL from January 2018 to December 2019 in our hospital were selected as the research subjects. According to the stone-free rate after ESWL, they were divided into stone clearance group and stone remains group. To compare between the preoperative clinical data and postoperative complications of the two groups, the clinical predictors of stone-free rate was assessed using multivariate analyses. ROC curve was used to evaluate the accuracy and cutoff value.Results:Among the 151 patients, 113 (74.83%) excluded their stones after ESWL. There was no significant difference in gender, body mass index (BMI), stone size and location between the two groups, but there was a significant difference in age, visual analog score (VAS), stone course, stone CT value and UWT (P<0.05). Multivariate analysis showed that stone CT value and UWT could be used as independent predictors of ESWL. ROC analysis showed that 3.05 mm was the optimal cut-off value for UWT, with a predictive accuracy of 0.918. In addition, low UWT had a significantly lower non-anticipated emergency surgery rate than high UWT (P<0.05).Conclusion:Stone CT value and UWT are independent predictors of stone clearance rate after ESWL. UWT has a better predictive value for ESWL.

参考文献：

[1] TAGUCHI K,CHO S Y,NG A C,et al.The urological association of Asia clinical guideline for urinary stone disease[J].Int J Urol,2019,26(7):688-709.
[2] CHOO M S,HAN J H,KIM J K,et al.The transgluteal approach to shockwave lithotripsy to treat distal ureter stones:A prospective,randomized,and multicenter study[J].World J Urol,2018,36(8):1299-1366.
[3] OZGOR F,TOSUN M,KAYALI Y,et al.Exteral validation and evaluation of reliability and validity of the triple D score to perdict stone-free status after extracorporeal shockwave lithotripsy[J].J Endourol,2017,31(2):169-173.
[4] YAMASHITA S,KOHJIMOTO Y,IGUCHI T,et al.Variation coefficient of stone density:a novel predictor of the outcome of extracorporeal shock wave lithotripsy[J].J Endourol,2017,31(4):384-390.
[5] KOGAN M I,BELOUSOV I I,YASSINE A M,et al.The effiectiveness of extracorporeal shockwave lithotripsy in treating proxima ureteral stones[J].Urologiia,2017,5:5-8.
[6] WAQAS M,SAQIB I U,IMRAN J M,et al.Evaluating the importance of different computed tomography scan-based factors in predicting the outcome of extracorporeal shockwave lithotripsy for renal stones[J].Investig Clin Urol,2018,59(1):25-31.
[7] KIM J W,CHAE J Y,KIM J,et al.Computed tomographybased novel prediction model for the stone-free rate of ureteroscopic lithotripsy[J].Urolithiasis,2014,42(1):75-79.
[8] 刘彼得,李循,文斌,等.输尿管壁厚度诊断输尿管结石嵌顿的临床研究[J].临床泌尿外科杂志,2019,34(3):176-179.
[9] PREMINGER G M,TISELIUS H G,ASSIMOS D G,et al.Guideline for the management of ureteral calculi[J].Eur Urol,2007,52:1610-1631.
[10] 冯波,郭晓,郑宝寿.CT值对输尿管结石ESWL疗效的预测价值[J].临床泌尿外科杂志,2007,22(3):199-200.
[11] 王福明.输尿管结石CT值与选择性体外震波碎石(ESWL)治疗的相关性分析[J].影像研究与医学应用,2018,23(2):160-161.
[12] KARLSEN S J,RENKEL J,TAHIR A R,et al.Extracorporeal shockwave lithotripsy versus ureteroscopy for 5-to-10mm stones in the proximal ureter:prospective effectiveness patient-preference trial[J].J Endourol,2007,21(1):28-33.
[13] YOSHIDA T,INOUE T,OMURA N,et al.Ureteral wall thickness as a preoperative indicator of impacted stones in patients with ureteral stones undergoing ureteroscopic lithotripsy[J].Urology,2017,106:45-49.
[14] MUGIYA S,ITO T,MARUYAMA S,et al.Endoscopic features of impacted ureteral stones[J].J Urol,2004,171:89-91.
[15] SHIMPEI Y,YASUO K,TAKASHI I,et al.Ureteral wall volume at ureteral stone site is a critical predictor for shock wave lithotripsy outcomes:comparison with ureteral wall thickness and area[J].Urolithiasis,2020,48(4):361-368.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录