输尿管镜钬激光碎石术后残留结石的危险因素分析  

Risk Factors of Residual Stone after Ureteroscopy Holmium Laser Lithotripsy

作　　者：王应洪[1] 张霞[1] 陈春梅[1] 段晨阳[2] 王燕[2] 肖胜[2] 

机构地区：[1]泸州医学院附属中医院,四川泸州646000 [2]第三军医大学遗传学教研室,重庆400038

出　　处：《现代生物医学进展》2013年第35期6918-6921,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(30872464)

摘　　要：目的:分析与输尿管镜钬激光碎石术后致使结石残留相关的临床危险因素。方法:选取我院214例接受输尿管镜钬激光碎石术的输尿管结石患者进行回顾性分析,对14个特征性临床因素与结石残留的关系应用单因素方差分析进行评价,对存在相关性的临床因素再应用计算机COX比例风险模型进行多因素分析。结果:全组患者结石残留率为42.52%(91/214)。单因素方差分析:ESWL史、患侧肾功能、结石位置、结石最大径、击碎后最大径、术后第1日输液量、术后第1日尿量、术后下床时间、术后解痉利尿药使用与术后结石残留相关(P值均<0.05);经过COX比例风险模型检测,患侧肾功能、结石位置、击碎后最大径、是结石残留的危险因素(P<0.05),而术后第1日尿量及术后解痉利尿药使用是结石残留的保护因素(P<0.05)。结论:患侧肾功能不良、结石位于上段、击碎后直径仍大易导致残留结石,而术后第1天尿量较多且适当应用解痉利尿药能减少残留结石。Objective： To analyze the risk factors of residual stone after holmium laser lithotripsy. Methods： A retrospective analysis on 214 patients with ureteral calculus who were treated by holmium laser lithotripsy. 14 possible risk factors which could affect the residual stone of patients with ureteral calculus were selected and the correlations of clinical factors and residual stone were analyzed by one-way ANOVA analysis. Furthermore, the relevant clinical factors were taken to multi-variable statistical analysis by COX proportional hazard model. Results： The occurrence of the 214 patients with ureteral calculus about the residual stone was 42.52% （91/214）. The results have showed that the major significant risk factors could influence the occurrence of residual stone for patients with ureteral calculus on the ESWL history, the renal function of the affected side, the calculus location, the calculus maximum diameter, the maximum diameter of fragment, the infusion volume, the urinary volume of first day after the operation, the time for getting up the bed and the application of anti-spasmodic or diuresis drugs （P〈0.05）. The clinical factors of renal function of the affected side, calculus location and maximum diameter of fragment were the essential risk factors of residual stone by COX proportional hazard model （P〈0. 05）; However, the urinary volume of the first day after the operation and the application of anti-spasmodic or diuresis drugs were the protective factors for prognosis （P〈0.05）. Conclusion： The poor renal fimction of the affected side, calculus located upper urinary tract and great diameter of fragment could induce the residual stone, but many urinary volume of 1st post-operation and the right drug application could reduce the residual stone.

关 键 词：输尿管结石 钬激光 结石残留 危险因素 COX比例风险模型 

分 类 号：R693[医药卫生—泌尿科学]