经皮肾镜取石术后肾周血肿列线图模型的建立  

Establishment of a nomogram model perirenal hematoma columns after percutaneous nephrolithotomy

作　　者：张曦才 郑慧敏[2] 张红冉[3] 李凤岳 曹现祥[3] 沈大庆[3] 曹先德[3] ZHANG Xicai;ZHENG Huimin;ZHANG Hongran;LI Fengyue;CAO Xianxiang;SHEN Daqing;CAO Xiande(Clinical Medical College of Jining Medical University,Ji Ning,Shan Dong 272000,China;Scientific Research Office,Affiliated Hospital of Jining Medical University,Ji Ning,Shan Dong 272000,China;Department of Urology,Affiliated Hospital of Jining Medical University,Jining,Shandong 272000,China)

机构地区：[1]济宁医学院临床医学院,山东济宁272000 [2]济宁医学院附属医院科研处,山东济宁272000 [3]济宁医学院附属医院泌尿外科,山东济宁272000

出　　处：《中国医学工程》2023年第3期1-7,共7页China Medical Engineering

基　　金：山东省医药卫生科技发展技术项目(202104050410);济宁市重点研发计划项目(2021YXNS009)。

摘　　要：目的探讨经皮肾镜取石术后出现肾周血肿相关的危险因素,建立其风险列线图预测模型。方法回顾性分析2019年1月至2021年12月济宁医学院附属医院泌尿外科行经皮肾镜取石术的451患者的临床资料。根据术后是否发生肾周血肿以及血肿的大小分为三组(大血肿组、小血肿组、无血肿组),比较三组之间的差异因素。结果经皮肾镜取石手术共有89例患者术后出现肾周血肿,其中大血肿为27例,小血肿为62例。单因素分析中,年龄、体重指数(BMI)、皮肤至结石的距离、结石的大小、无肾积水是术后血肿的高危因素(P<0.05),在Logistic回归多因素分析中,年龄(OR=0.972,95%CI:0.948~0.996,P=0.020)、无肾积水(OR=2.478,95%CI:1.292~4.752,P=0.006)是小血肿的独立危险因素;年龄(OR=0.961,95%CI:0.926~0.997,P=0.033)、结石的大小(OR=1.182,95%CI:1.011~1.380,P=0.036)、皮肤至结石的距离(OR=0.973,95%CI:0.948~0.999,P=0.043)、无肾积水(OR=2.844,95%CI:1.196~6.763,P=0.018)是大血肿的独立危险因素,使用上述危险因素建立列线图预测模型,术后肾周小血肿的ROC曲线下面积(AUC)为0.639,术后肾周大血肿的ROC曲线下面积(AUC)为0.735,具有较好的预测价值。结论年龄、无积水是经皮肾镜取石术后肾周血肿的独立预测因素,同时结石大小及SSD亦是术后肾周大血肿的独立预测因素,本研究构建的列线图预测模型对经皮肾镜取石术后发生肾周血肿具有较好的预测价值。【Objective】To investigate the risk factors associated with the development of perirenal hematoma after percutaneous nephrolithotomy,and establish a risk prediction nomogram model.【Methods】The clinical data of 451 patients who underwent percutaneous nephrolithotomy in the Department of Urology of the Affiliated Hospital of Jining Medical University from January 2019 to December 2021 were retrospectively analyzed.The patients were divided into three groups(large hematoma group,small hematoma group,and no hematoma group)according to whether perirenal hematoma occurred after surgery and the size of the hematoma,and the difference factors between the three groups were compared.【Results】A total of 89 patients developed perirenal hematoma after percutaneous nephrolithotomy,including 27 cases of large hematoma and 62 cases of small hematoma.Univariate analysis showed significant differences in age,BMI,skin-to-stone distance,size of the stone,and without hydronephrosis.Multivariate Logistic regression showed that age(OR=0.972,95%CI:0.948–0.996,P=0.020)and without hydronephrosis(OR=2.478,95%CI:1.292–4.752,P=0.006)were risk factors for small hematoma.Multivariate Logistic regression showed that age(OR=0.961,95%CI:0.962-0.997,P=0.033),size of ston es(OR=1.182,95%CI:1.011-1.380,P=0.036),skin-to-stone distance(OR=0.973,95%CI:0.948-0.999,P=0.043)and without hydronephrosis(OR=2.844,95%CI:1.196-6.763,P=0.018)were risk factors for large hematoma.Based on the above risk factors,a risk prediction nomogram model was established,the area under the ROC curve(AUC)for the small perirenal hematoma was 0.639,and the AUC for the large perirenal hematoma was 0.735,which had a good predictive value.【Conclusion】Age and without hydronephrosis are independent predictors of perirenal hematoma after percutaneous nephrolithotomy,and the size of stones is also an independent predictor of postoperative large perirenal hematoma.The nomogram prediction model has good predictive value on the occurrence of perirenal hematoma after per

关 键 词：经皮肾镜取石术 肾周血肿 尿石症 多因素分析 列线图 

分 类 号：R692.4[医药卫生—泌尿科学]