摘要
目的:探讨输尿管软镜钬激光碎石术治疗输尿管上段复杂性结石后双J管附壁结石形成的原因,以预防结石形成。方法:回顾性选择2022年3月到2023年3月于我院接受输尿管软镜钬激光碎石术治疗的240例输尿管上段复杂性结石患者为研究对象。按照患者双J管附壁情况,分为结石阴性组(115例)和结石阳性组(125例)。通过倾向性评分匹配(PSM)、LASSO及多因素Logistic回归分析治疗输尿管上段复杂性结石后双J管附壁结石的预测因素,构建列线图预测模型并进行模型评价。结果:匹配卡钳值为0.09,匹配前结石阳性组和结石阴性组的倾向性评分不均衡,匹配后两组的倾向评分总体趋势一致,大部分组间的标准差在5%以下。多因素Logistic回归分析后得出BUA、Cys-C、BUN、Scr、TC、TG、eGFR均为患者双J管附壁结石形成的独立影响因素(P<0.05)。基于七项独立影响因素构建的列线图预测模型结果显示,内部验证前后受试者工作特征(ROC)曲线下面积(AUC)分别为0.836(95%CI:0.801~0.895,P<0.05)、0.895(95%CI:0.884~0.920,P<0.05),提示该预测模型具有较好的区分度和精确度。结论:输尿管上段复杂性结石患者行输尿管软镜钬激光碎石术术后双J管附壁结石的情况发生可能由于BUA、Cys-C、BUN、Scr、TC、TG明显升高,eGFR明显降低导致。
Objective:To investigate the causes of double J stent wall stones after complicated upper ureteral calculi treated with flexible ureteroscopic holmium laser lithotripsyand to prevent stone formation.Methods:A total of 240 patients with complicated upper ureteral stones from March 2022 to March 2023 were selected as the study subjects.The patients were divided into stone-negative group(115 cases)and stone-positive group(125 cases).The predictive factors of double J ureteral calculi after treatment of complex upper ureteral calculi were analyzed by propensity score matching(PSM),LASSO and multivariate Logistic regression,and a nomogram prediction model was constructed and the model was evaluated.Results:The matching caliper value was 0.09,the propensity scores of the negative and positive groups were unbalanced,and the overall trend of propensity scores between the two groups after matching was consistent,with the standard deviation below 5%among most groups.Multivariate Logistic regression analysis showed that BUA,Cys-C,BUN,Scr,TC,TG,and eGFR were all independent risk factors affecting the formation of J stent wall stones(P<0.05).The results of the nomogram prediction model based on seven independent influencing factors showed that the area under the receiver operating characteristics curvewas 0.836(95%CI:0.801-0.805,P<0.05)and 0.895(95%CI:0.884~0.920,P<0.05),suggesting that the prediction model had good differentiation and accuracy.Conclusion:The occurrence of wall stones in double J stent after flexible ureteroscopic holmium laser lithotripsy may be caused by a significant increase ofBUA,Cys-C,BUN,Scr,TC,TG,and the decrease of eGFR.
作者
韩增箎
刘禹
刘丽
邵建国
郭环宇
庄建
宋飞
赵谦
侯飓
黄伟
Han Zengchi;Liu Yu;Liu Li;Shao Jianguo;Guo Huaiyu;Zhuang Jian;Song Fei;Zhao Qian;Hou Ju;Huang Wei(Department of Urology,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001,China;Jinan Beicheng Hospital,Jinan 250031,China)
出处
《微创泌尿外科杂志》
2023年第4期256-263,共8页
Journal of Minimally Invasive Urology
关键词
输尿管镜
输尿管结石
ureteroscopes
ureteral calculi
