摘要
目的明确小于6 mm输尿管结石患者需行外科干预的指征,并分析临床相关因素的相关性及临床意义,对其制定合理有效的治疗方案及早干预治疗。方法根据结石是否能自行排出将患者分为两组,手术组及对照组,收集小于6 mm输尿管结石患者的一般资料,包括性别、年龄、体质量指数(body mass index,BMI)、既往史(高血压史、糖尿病史)、结石位置、结石最大直径、结石CT值、结石处输尿管壁最大厚度(maximum ureteral wall thickness,UWTmax)、肾积水直径、输尿管结石以下输尿管情况(行静脉肾盂造影检查输尿管是否迂曲、造影剂是否通过)等临床资料比较两组各项临床数据的差异,对有差异的指标进行多因素logistic回归分析小结石无法排出原因,绘制受试者工作特征曲线(receiver operating characteristic,ROC)并分析独立预测因素的最佳界值。结果回顾性分析2018年10月至2022年10月首都医科大学密云教学医院收治的102例小于6 mm输尿管结石患者的病例资料,其中男54例,女48例;平均年龄(47.9±13.1)岁,年龄27~75岁。随诊观察3个月,结石未排出行外科干预为治疗组(n=46),3个月内保守治疗结石排出为对照组(n=56)。单因素分析显示两组患者BMI、结石CT值、UWTmax差异有统计学意义(P<0.05),而年龄、性别、高血压病史、糖尿病病史、结石侧别、结石位置、肾积水直径差异无统计学意义(P>0.05);多因素logistic回归分析显示BMI(OR=1.097,95%CI 0.914~1.987)、UWTmax(OR=10.89,95%CI 3.89~28.98)均为影响输尿管结石排出的独立预测因素(P<0.05)。采用ROC曲线比较BMI、UWTmax预测效能,BMI的ROC曲线下面积为0.742,UWTmax的ROC曲线下面积为0.965,UWTmax界值为3.78 mm。结论小于6 mm的输尿管小结石中,患者高BMI合并UWTmax大于3.78 mm,早期干预比长期保守治疗更好。
Objective To investigate the clinical indicators and influencing factors which could be used to perform surgical intervention from small calculus(less than 6 mm)by comparing clinical characteristics of patient.Method The patients were divided into two groups,the operation group and the control group according to whether the stones were surgically intervened or not.The general data of patients with tireteral stones less than 6 mm were collected,including gender,age,past history(history of hypertension,history of diabetes),stone location,stone transverse diameter,stone CT value,maximum ureteral wall thickness(UWTmax),diameter of hydronephrosis,ureteral conditions below lareteral stones(whether the ureter was tortuous by intravenous pyelography,whether the contrast agent passed)and other clinical data to compare the differences between the two groups.Multivariate logistic regression was used to analyze the independent predictors of incarcerated stones.The receiver operating characteristic(ROC)curve was drawn and the optimal threshold of independent predictors was analyzed.Results The clinical data of 102 patients with ureteral calculi less than 6mm admitted to Miyun Teaching Hospital of Capital Medical University from October 2018 to October 2022 were retrospectively analyzed,including 54 males and 48 females.The mean age was(47.9±13.1)years old,ranging from 27 to 75 years old.According to different treatment methods(whether surgical intervention),the patients were divided into control group(n=56)and treatment group(n=46).Univariate analysis showed that there were significant differences in BMI,stone CT value and UWTmax between the two groups(P<0.05).Multivariate logistic regression analysis showed that BMI(OR=1.097,95%CI 0.914-1.987)and UWTmax(OR=10.S9,95%CI 3.89-28.98)were independent predictors of ureteral stone discharge(P<05).ROC curve was used to compare the predictive efficacy of BMI and UWTmax.The area under the ROC curve of BMI was 0.742,and the area under the ROC curve of UWTmax was 0.965.The cut-off value of UWT-max was 3.78 mm.Conclusion In small ureteral stones less than 6 mm,patients with high BMI and UWTmax greater than 3.78 mm,early intervention is better than long-term conservative treatment.
作者
左超
谷亚明
刁英智
王冰
张明华
刘红雷
Zuo Chao;Gu Yarning;DiaoYingzhi;Wang Bing;Zhang minghua;Liu Honglei(Department of Urology,Beijing Miyun District Hospital,Peking University First Hospital-Miyun Hospital,Beijing 101500,Chnia)
出处
《泌尿外科杂志（电子版）》
2023年第2期59-63,共5页
Journal of Urology for Clinicians(Electronic Version)
关键词
输尿管结石
外科干预
相关因素
Ureteral calculi
Surgical intervention
Related factors
