结石床输尿管壁最大厚度对体外冲击波碎石术治疗输尿管结石效果的预测价值  

Predictive value of maximum ureteral wall thickness at stone bed position for extracorporeal shock wave lithotripsy in the treatment of ureteral calculi

作　　者：齐伟[1] 席俊华[1] 徐忠乐 魏灿[1] 王一哲 陆智强 王鹏 何艳 杨丽[1] 张艳斌[1] Qi Wei;Xi Junhua;Xu Zhongle;Wei Can;Wang Yizhe;Lu Zhiqiang;Wang Peng;He Yan;Yang Li;Zhang Yanbin(Department of Urology,the Second People's Hospital of Hefei,Hefei 230001,China)

机构地区：[1]合肥市第二人民医院泌尿外科,合肥230001

出　　处：《中华泌尿外科杂志》2022年第11期845-849,共5页Chinese Journal of Urology

摘　　要：目的探讨结石床输尿管壁最大厚度(UWT)对ESWL治疗输尿管结石效果的预测价值。方法回顾性分析2020年1月至2020年12月于合肥市第二人民医院行ESWL治疗138例输尿管结石患者的临床资料。男91例,女47例;年龄(50.9±14.8)岁;体质量指数(25.3±3.6)kg/m^(2);结石位于左侧73例,右侧65例;输尿管上段结石70例,中段结石18例,下段结石50例;结石长径为8.5(7.5,10.5)mm;结石CT值为509(343,783)HU;肾盂前后径为12.0(10.1,16.0)mm;结石皮肤距离为(111.5±21.0)mm;UWT为(2.8±0.8)mm。患者在碎石前均行泌尿系CT平扫,在CT图像上测量UWT,根据术后2周结石清除情况将患者分为碎石成功组和碎石失败组。采用单因素分析比较两组患者各项指标的差异,对有差异的指标采用多因素logistic回归分析ESWL疗效的独立预测因素。采用受试者工作特征(ROC)曲线计算各项独立预测因素的曲线下面积(AUC),并分析最佳临界值以及敏感性和特异性,根据临界值分组,比较两组碎石成功率的差异。结果本研究138例均顺利完成ESWL,一期碎石成功率为71.7%(99/138)。单因素分析结果显示,碎石成功组较碎石失败组结石长径[8.0(7.3,9.8)mm与10.5(9.0,11.5)mm]、结石CT值[425(329,715)HU与663(429,994)HU]、肾盂前后径[12.0(9.7,15.9)mm与15.0(11.2,18.0)mm]、结石皮肤距离[(109.0±19.8)mm与(117.6±23.3)mm]、UWT[(2.5±0.6)mm与(3.7±0.8)mm]均更低,差异均有统计学意义(P<0.05),两组年龄、性别、体质指数、结石侧别、结石位置差异均无统计学意义(P>0.05)。多因素logistic分析结果显示结石长径(OR=1.393,P=0.015)、结石CT值(OR=1.002,P=0.043)和UWT(OR=17.997,P<0.001)均为ESWL治疗输尿管结石效果的独立预测因素。ROC曲线显示,UWT的AUC最大(AUC=0.898,P<0.001),其次为结石长径(AUC=0.744,P<0.001)、结石CT值(AUC=0.672,P=0.002)。UWT的最佳临界值为3.19 mm,其预测ESWL碎石成功的敏感性为91.9%,特异性为71.8%。根据最佳临界值将患者分�Objective To investigate the predictors of the efficacy of extracorporeal shock wave lithotripsy(ESWL)in the treatment of ureteral calculi,and to evaluate the predictive value of the maximum ureteral wall thickness(UWT)in the treatment of ureteral calculi with ESWL.Methods The clinical data of 138 patients with ureteral calculi treated with ESWL in the Second People's Hospital of Hefei from January 2020 to December 2020 were retrospectively analyzed.There were 91 males and 47 females.The age was(50.9±14.8)years old.The body mass index was(25.3±3.6)kg/m^(2).The stones of 73 cases were located on the left side and 65 cases were on the right side.70 cases had upper ureteral stones,18 cases had middle ureteral stones,and 50 cases had lower ureteral stones.The median length of the stone was 8.5(7.5,10.5)mm.The CT value of the stone was 509(343,783)HU.The anteroposterior diameter of the renal pelvis was 12.0(10.1,16.0)mm,and UWT was(2.8±0.8)mm.All patients underwent urinary non-contrast CT before lithotripsy,and the UWT of the stone bed was measured on the CT images.According to the stone removal situation 2 weeks after the operation,the patients were divided into a successful lithotripsy group and a failed lithotripsy group.Univariate analysis was used to compare the differences of various indicators between the two groups,and multivariate logistic regression was used to analyze the independent predictors of ESWL in the treatment of ureteral calculi for the indicators.The receiver operating characteristic(ROC)curve was used to calculate the area under the curve(AUC)of each independent predictor,and the cut-off value,sensitivity and specificity were analyzed.Results All operations were successfully completed,and the success rate of the first-stage lithotripsy was 71.7%(99/138).The results of univariate analysis showed that the stone length diameter,stone CT value,anteroposterior diameter of renal pelvis,stone skin distance,and UWT were significantly different between the successful lithotripsy group and the failure

关 键 词：输尿管结石 输尿管壁厚度 体外冲击波碎石术 疗效 预测因素 

分 类 号：R699.4[医药卫生—泌尿科学]