体外冲击波碎石治疗单发输尿管结石及疗效预测

目的探讨体外冲击波碎石术（ESWL）治疗输尿管结石疗效的影响因素，并建立预测模型。方法2008年1月至2011年2月接受ESWL治疗的输尿管结石患者1116例，随访3个月。用X^2检验或t检验、秩和检验进行单因素分析来研究患者性别、年龄、身高、体重、病程、临床症状和结石特征等因素与疗效的关系，多因素分析采用Logistic逐步回归分析（Forward：LR法），建立Logistic回归预测模型。结果ESWL单次治疗输尿管结石成功率84．3％（941／1116）。单因素分析发现结石部位、结石长短径及肾绞痛对疗效均有影响。Logistic回归分析则显示结石部位、结石长短径及肾绞痛决定治疗的成功率，预测模型对碎石成功率的解释力良好（X^2=117．434，P〈0．001），并通过拟合优度检验（X^2=5．261，P=0．729），预测总体准确率为83．8％。结论结石部位、结石长短径及肾绞痛是ESWL治疗输尿管结石成功率的重要决定因素。

Prediction of outcome of extracorporeal shock wave lithotripsy for solitary ureteral calculi

Objective To determine the prognostic factors affecting the efficacy of extracorporeal shock wave lithotripsy （ESWL） for solitary ureteral calculi and to construct a predictive model of the probability of stone-free status. Methods Between January 2008 and February 2011, 1116 patients underwent ESWL monotherapy as first intervention. After 3 months of follow-up, the results of therapy were recorded. Chi-square test,t-test,and Mann-whithey U test were employed to analyze the correlations between patients＇ gender, age, height, weight, disease course, clinical symptoms, characteristics of stone and the outcome of the therapy. Logistic stepwise regression was used as a method of multivariate, and a predictive model was also con- structed. Results Stone-free rate of monotherapy of ESWL was 84.3~. Univariate analysis showed the patients＇ stone site, length, width and pre-ESWL renal colic had significant impacts on the outcome of treatment. Logistic regression analysis suggested a predictive model, whose variants included stone site, stone length, stone width, renal colic. The prediction model has a good ability of explanation of stone-free rate （X^2 = 117. 434, P〈0.001）, while the goodness of fit test is good（X^2 = 5. 261, P =0. 729）, and overall predictive accuracy was 83.8%. Conclusion Stone site, stone length ＆ width, pre-ESWL renal colic are prognostic factors determining outcome of ESWL for ureteral calculi.