影响第二次冲击波碎石术治疗上尿路结石患者成功的因素分析

目的 探讨影响第二次冲击波碎石术（extracorporeal shock wave lithotripsy, ESWL）治疗上尿路结石患者成功的因素。方法 回顾性分析2008年1月至2012年12月来本院接受第二次ESWL治疗的上尿路结石患者120例。根据患者上尿路结石有无完全排出分为成功组（n=80）和失败组（n=40）。回顾性分析所有患者的病历资料，相关因素分析包括性别、年龄、病程、BMI、结石侧别、结石位置、结石长度、结石宽度、结石数目、肾绞痛、血尿、肾积水程度、非增强螺旋CT值、冲击次数、冲击能量等指标。应用单因素、多因素非条件Logistic回归分析上尿路结石患者第二次ESWL治疗成功与否的危险因素分析。结果 120例上尿路结石患者临床特征显示，两组在病程、BMI、结石长度、结石宽度、结石数量、肾绞痛、肾积水程度、CT值、冲击次数方面差异有统计学意义（P＜0.05），在性别、年龄、结石侧别、结石位置、血尿、冲击能量方面差异无统计学意义（P＞0.05）。经单因素、多因素 Logistic 回归分析结果显示，BMI偏高、结石长度＞2 cm、存在肾绞痛、肾积水程度严重、CT值＞750 HU会增加上尿路结石患者第二次ESWL治疗失败的风险（P＜0.05）。结论 临床医师利用ESWL第二次治疗上尿路结石患者过程中，应格外注意患者BMI、结石长度、肾绞痛、肾积水程度、CT值等关键指标。

Analysis of the factors influencing the success of the second extracorporeal shock wave lithotripsy in the treatment of upper urinary calculi

Objective  To investigate the factors influencing the success of the second extracorporeal shock wave lithotripsy (ESWL) in the treatment of upper urinary calculi.Methods   Clinical data of 120 patients with upper urinary tract calculi who underwent second ESWL in our hospital between January 2008 and December 2012 were retrospective analyzed.According to stones were completely discharged, all patients were divided into the successful group (n=80) and failed group (n=40). A retrospective analysis of the medical records of all patients and analysis of related factors included gender, age, duration, body mass index, stone side, stone location, stone length, stone width and number of stones, renal colic, hematuria, degree of hydronephrosis, the value of non enhanced spiral CT, impact frequency, impact energy index were performed. Risk factors for the success of second ESWL in the treatment of patients with upper urinary tract calculi were analyzed by single factor and multiple factor non-conditional logistic regression analysis. Results  There were significant differences in the course of the disease, body mass index, length, width, stone, hydronephrosis, renal colic, CT value, the impact number between the two groups (P<0.05). There were not significant differences in gender, age, stone laterality, stone location, node difference hematuria, the impact energy between the two groups (P>0.05). Univariate and multivariate logistic regression analysis showed that body mass index was high, the stone length >2 cm, renal colic, hydronephrosis severity, CT value＞750 HU could increase the risk of failure in second ESWL for upper urinary tract calculi (P<0.05). Conclusions  We should pay attention to the patient's body mass index, stone length, renal colic, the degree of renal water, CT value, and other key indicators in the process of second use of ESWL in the treatment of upper urinary tract calculi.