肾下盏解剖对软式输尿管镜治疗肾下盏结石术后清石率的影响及预测模型构建  

Effects of subcalyx anatomy on stone clearance of lower pole stones treated with flexible ureteroscopy and construction of prediction model

作　　者：索杰 段万里[1,2] 邓骞 杨海燕[2] 程永毅 孙羿 SUO Jie;DUAN Wanli;DENG Qian;YANG Haiyan;CHENG Yongyi;SUN Yi(Medical Department,Xi an Jiaotong University,Xi’an 710061;Department of Urology,Shaanxi Provincial People’s Hospital,Xi’an 710068;Department of Urology,Baoji Central Hospital,Baoji 721008,China)

机构地区：[1]西安交通大学医学部,陕西西安710061 [2]陕西省人民医院泌尿外科,陕西西安710068 [3]宝鸡市中心医院泌尿外科,陕西宝鸡721008

出　　处：《现代泌尿外科杂志》2021年第11期914-917,共4页Journal of Modern Urology

基　　金：陕西省重点项目-社会发展领域(No.2017ZDXM-SF-050);陕西省一般项目-青年项目(No.2020JQ-945)。

摘　　要：目的了解肾下盏解剖结构对输尿管软镜治疗肾下盏结石术后结石清除的影响。方法回顾性分析陕西省人民医院2015至2019年入院行软式输尿管镜下肾下盏结石钬激光碎石的患者,比较患者临床资料及肾下盏解剖结构数据,多因素Logistic回归分析影响术后结石清除的独立危险因素,构建预测模型,绘制受试者工作特征曲线(ROC)并计算约登指数确定连续变量的临界值及曲线下面积(AUC)。结果按纳入及排除标准筛选后共收集肾下盏结石的患者287例,术后结石完全清除228例(79.44%)。多因素Logistic回归分析显示,下盏肾盂角(IPA)较小、肾盂下盏高度(CPH)较高、结石最大径(LDS)较大是输尿管软镜治疗肾盂下盏结石患者结石清除的独立影响因素。通过ROC曲线计算AUC依次为:结石清除风险评分(RS)>IPV>CPH>LSD。RS最大约登指数为0.753,其对应联合预测因子的值为20.34。当以RS=20.34为临界点时,其敏感度为0.838,特异度为0.915。结论IPA、CPH及LSD对软性输尿管镜治疗肾下盏结石术后结石清除有显著影响,联合预测模型具有较高的特异性和敏感性,对术前选择手术方式及术后预测结石清除具有指导意义。Objective To evaluate the impact of the subcalyx anatomy on the stone clearance in patients with lower pole stones(LPS)after using flexible ureteroscopy and Holmium laser lithotripsy(fURSL).Methods Clinical and subcalyx anatomical data of patients who underwent fURSL for LPS in Shaanxi Provincial People s Hospital during 2015 and 2019 were retrospectively analyzed.Multivariate analysis was performed to determine the risk factors for stone clearance and a predictive model was constructed.The receiver operating characteristic(ROC)curve was drawn and Youden index was used to determine the cut-off value and the area under ROC curve(AUC).Results A total of 287 patients were enrolled,and 228(79.44%)had stones completely cleared after fURSL.Multivariate analysis showed that small infundibular pelvic angle(IPV),long infundibular length(IL),high caliceal pelvic height(CPH)and large stone diameter(LSD)were independent influencing factors for stone clearance(P<0.001).The AUC in descending order was:RS>IPV>CPH>LSD.The maximum Youden index of RS was 0.753,and the cut-off value was 20.34.When RS was 20.34,the sensitivity was 0.838 and specificity was 0.915.Conclusion The IPV,CPH and LSD are the most important predictors for the treatment of LPS after fURSL.The combined prediction model can predict the stone clearance accurately.

关 键 词：肾下盏结石 结石清除率 影响因素 Logistic回归 

分 类 号：R699.2[医药卫生—泌尿科学]