摘要
目的分析输尿管上段结石患者输尿管软镜联合钬激光碎石术(FURL)术中结石逃逸的影响因素,并构建预测模型构建。方法回顾性收集2020年1月-2021年12月收治的128例经FURL术治疗的输尿管上段结石患者临床资料,根据患者术中是否发生结石逃逸将患者分为结石逃逸组(29例)和结石未逃逸组(99例)。统计输尿管上段结石患者经FURL术治疗术中结石逃逸的单因素,采用多因素Logistic回归分析输尿管上段结石患者经FURL术治疗术中结石逃逸的影响因素并构建预测模型,采用受试者工作特征曲线(ROC)分析预测模型对输尿管上段结石患者FURL术中结石逃逸风险的预测价值。结果多因素Logistic回归分析结果显示,结石大小≥1 cm、术中泵注0.9%氯化钠注射液压力>200 mm Hg、术前肾积水严重度为轻中度均是输尿管上段结石患者经FURL术治疗术中结石逃逸的独立危险因素(OR=2.188、3.647、2.821,P<0.05),术中使用输尿管管路封堵器为输尿管上段结石患者经FURL术治疗术中结石逃逸的保护因素(OR=0.369,P<0.05)。根据多因素Logistic回归分析结果建立回归方程模型:logit(P)=-11.152+结石大小×0.783+术中泵注0.9%氯化钠注射液压力×1.294-术中使用输尿管管路封堵器×0.996+术前肾积水严重度×1.037。ROC曲线分析结果显示,当logit(P)>11.82时,AUC值为0.906,95%CI为0.842~0.951,敏感度为72.41%,特异度为92.93%。结论输尿管上段结石患者经FURL术治疗术中结石逃逸的独立危险因素包括结石大小≥1 cm、术中泵注0.9%氯化钠注射液压力>200 mm Hg、术前肾积水严重度为轻中度,保护因素为术中使用输尿管管路封堵器,Logistic回归模型对其预测价值较高,临床可据此对输尿管上段结石患者FURL术中发生结石逃逸的相关影响因素进行预测,降低患者发生结石逃逸的风险。
Objective To analyze the infl uencing factors of stone escape during flexible ureteroscopy combined with holmium laser lithotripsy(FURL)in patients with upper ureteral stones,and to construct a prediction model.Methods The clinical data of 128 patients with upper ureteral calculi treated by FURL from January 2020 to December 2021 in our hospital were retrospectively analyzed.According to whether or not the calculi escaped during operation,the patients were divided into the calculus escape group(29 cases)and the calculus non-escape group(99 cases).The single factor of stone escape in patients with upper ureteral calculi treated by FURL was counted,and the multivariate Logistic regression was used to analyze the infl uencing factors of stone escape in patients with upper ureteral calculi during FURL and establish a prediction model.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of the prediction model for the risk of stone escape during FURL in patients with upper ureteral calculi.Results Multivariate Logistic regression analysis showed that the stone size≥1 cm,0.9%sodium chloride injection pumped intraoperatively at a pressure>200 mm Hg and mild to moderate hydronephrosis before operation were all independent risk factors of stone escape in patients with upper ureteral calculi during FURL(OR=2.188,3.647,2.821,P<0.05),The use of ureteral occluder during operation was a protective factor of stone escape in patients with upper ureteral calculi during FURL(OR=0.369,P<0.05).The regression equation model was established according to the results of multivariateLogistic regression analysis:logit(P)=-11.152+stone size×0.783+pressure of 0.9%sodium chloride injection pumped during operation×1.294-ureteral obstruction device used during operation×0.996+severity of hydronephrosis before operation×1.037.ROC analysis showed that when logit(P)>11.82,AUC value was 0.906,95%CI was 0.842-0.951,diagnostic sensitivity was 72.41%,specificity was 92.93%.Conclusion Independent risk factors for calculi escape in patients with upper ureteral calculi during FURL include calculi size≥1 cm,intraoperative pumping pressure of 0.9%sodium chloride injection>200 mm Hg,mild to moderate hydronephrosis before operation.And the protective factor is the use of ureteral occluder during operation for these patients.Logistic regression model has a high predictive value,which can be used to predict the related infl uencing factors of stone escape in patients with upper ureteral calculi during FURL,so as to reduce the risk of stone escape.
作者
黄英杰
杨钧显
杨向利
高强利
HUANG Yingjie;YANG Junxian;YANG Xiangli;GAO Qiangli(Department of Urology,Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430064,China;Department of Urology,Puren Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430081,China)
出处
《长春中医药大学学报》
2023年第4期448-452,共5页
Journal of Changchun University of Chinese Medicine
基金
湖北省卫生和计划生育委员会联合基金项目(WJ2018H0117)。
