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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
作者:王芝千  朱晓东  郑安  王明清  王国栋  邵强 
单位:首都医科大学电力教学医院 泌尿外科, 北京 100073
关键词:输尿管壁厚度 体外冲击波碎石 结石清除率 
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.

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