输尿管软镜碎石术202例手术时间的影响因素  

Influencing factors of operation time of flexible ureteroscopy lithotripsy

作　　者：赵国斌[1] 凌海滨[1] 刘鑫 唐玉红[2] 苏宏伟[1] 唐立东 冯超 李朝阳 李向东[1] ZHAO Guobin;LING Haibin;LIU Xin;TANG Yuhong;SU Hongwei;TANG Lidong;FENG Chao;LI Chaoyang;LI Xiangdong(Department of Urology,First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;College of Laboratory Medicine,Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Surgery,Chicheng County Hospital,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院泌尿外科,河北张家口075000 [2]河北北方学院检验学院,河北张家口075000 [3]张家口市赤城县医院外科,河北张家口075000

出　　处：《安徽医药》2020年第7期1317-1320,共4页Anhui Medical and Pharmaceutical Journal

基　　金：河北省科技计划自筹经费项目(172777182);河北省重点科技研究计划项目(20180839)。

摘　　要：目的评价输尿管软镜碎石术(FURS)手术时间的影响因素。方法搜集河北北方学院附属第一医院2013年12月至2018年12月行FURS病人202例,均采用科医人钬激光碎石,术后3个月复查CT,151例病人无残石。根据术后结果将202例病人分为三组,无残石组、残石≤4 mm组、残石>4 mm组。比较三组病人一般资料及围手术期的情况,可能影响手术时间的因素11个。手术时间和可能影响因素之间的相关性采用spearman相关系数和多元性线性回归模型进行分析。结果无残石组结石数量(2.1±1.7)个,结石体积(648.6±692.5)mm^3,肾下极结石102例,最大CT值(1 051.4±4 103.0)HU,平均CT值(926.4±343.3)HU,手术时间(79.3±32.5)min均显著高于残石≤4 mm组(2.8±1.9)个、(1 198.8±1 102.0)mm^3、18例、(1 248.4±340.0)HU,(1087.3±351.9)HU,(106.2±32.4)min;并显著高于残石>4 mm组(3.4±2.0)个、(3 625.9±4 154.5)mm^3、10例、(1 358.6±303.9)HU,(1 109.5±314.5)HU,(112.5±24.2)min。残石≤4 mm组结石体积(1 198.8±1 102.0)mm^3显著高于残石>4 mm组(3 625.9±4 154.5)mm^3。spearman相关系数表明了手术时间与结石体积呈显着正相关(r=0.405,P<0.001),手术时间和CT值之间呈正相关(r=0.321,P<0.001)。多元性线性回归模型分析采用强制进入和逐步选择的方法得出预测FURS手术时间的六个因素:术前置入D-J管,结石体积,CT值,外科医生经验,性别和软镜鞘直径。建立的预测手术时间模型中的决定系数(R2)为0.318,预测模型的平均R2值为0.318±0.049。结论根据病人特征和外科医生的经验制订了FURS手术时间模型,术前能可靠地预测手术时间,计划是否分期FURS以及避免手术并发症。Objective To predict the influencing factors of the operation time of flexible ureteroscopy(FURS)operation time.MethodsThe clinical data of 202 patients with ureteroscopy lithotripsy(FURS)from the First Affiliated Hospital of Hebei NorthUniversity from December 2013 to December 2018 were collected.All patients were treated with laser lithotripsy.The CT was re-viewed 3 months after operation,and 151 patients had no residual stones.According to the postoperative results,202 patients weredivided into three groups,no residual stone group,residual stone≤4 mm group and residual stone>4 mm group.Comparing thegeneral data and the perioperation conditions of the three groups,there were 11 factors may affect the operation time.The correla-tion between operative time and possible influencing factors was analyzed using the spearman correlation coefficient and the multi-ple linear regression model.ResultsIn the non-residual stone group,the number of stones(2.1±1.7),stone volume(648.6±692.5)mm^3,102 cases of inferior pole stones,maximum CT value(1051.4±4103.0)HU,average CT value(926.4±343.3)HU,operationtime(79.3±32.5)min,all these index were significantly higher than the residual stone≤4 mm group(2.8±1.9),(1198.8±1102.0)mm^3,18 cases,(1248.4±340.0)HU,(1087.3±351.9)HU,(106.2±32.4)min;and also significantly higher than the re-sidual stone>4 mm group(3.4±2.0),(3625.9±4154.5)mm^3,10 cases,(1358.6±303.9)HU,(1109.5±314.5)HU,(112.5±24.2)min.Stone volume(1198.8±1102.0)mm^3in group was significantly higher than the group(3625.9±4154.5)mm^3.The spear-man correlation coefficient showed a significant positive correlation between operation time and stone volume(r=0.405,P<0.001),and a positive correlation between operative time and CT value(r=0.321,P<0.001).Multivariate linear regression modelanalysis used forced entry and stepwise selection methods to derive six factors predicting FURS operation time:preoperative D-Jtube,stone volume,CT value,surgeon experience,gender and soft sheath diameter.The coefficient of determi

关 键 词：肾结石/外科学 输尿管镜检查 线性模型 手术时间 

分 类 号：R699.4[医药卫生—泌尿科学]