输尿管硬镜碎石术治疗输尿管上段结石的疗效影响因素分析

目的探讨输尿管硬镜钬激光碎石术治疗输尿管上段结石的疗效影响因素。 方法回顾分析2012年1月至2018年12月我院泌尿外科收治的1 704例输尿管上段结石行输尿管硬镜钬激光碎石病例的临床资料，并根据手术结果分为成功组（n=1560）和失败组（n=144），对两组参数进行比较，并采用Logistic回归分析方法，分析影响输尿管上段结石患者行输尿管硬镜钬激光碎石成功率的相关因素。 结果1 704例患者一次碎石成功1 560例，总碎石成功率为91.5%。结石的侧别、结石停留时间、集合系统宽度、结石CT值、结石数目、是否存在上镜困难对输尿管上段结石碎石成功率有显著影响（P<0.05），但是否存在上镜困难是碎石成功与否的独立影响因素，与是否一次清石成功呈显著负相关（回归系数=-1.233，P<0.01）。 结论输尿管硬镜碎石治疗输尿管上段结石成功率高，其疗效与多种因素相关，是否存在上镜困难可能是主要影响因素。输尿管硬镜碎石术仍然是输尿管上段结石外科微创治疗的理想选择术式。

Analysis of factors influencing the efficacy of rigid ureteroscopic lithotripsy in treating upper ureteral calculi

ObjectiveTo explore the influencing factors on the efficacy of holmium laser lithotripsy under rigid ureteroscope for upper ureteral calculi. MethodsFrom January 2012 to December 2018, 1704 cases of upper ureteral calculi treated by rigid ureteroscopic holmium laser lithotripsy were analyzed retrospectively. According to operative results, they were divided into successed group (n=1 560) and failed group (n=144). Two groups of parameters were compared, and analyzed related factors under logistic regression analysis about the success rate of holmium laser lithotripsy under rigid ureteroscope for upper ureteral calculi. ResultsIn 1 704 cases, 1 560 cases underwent at one-stage lithotripsy successfully, and total success rate was 91.5%. There were significant effects in success rate of lithotripsy on the side and dwelling time of the calculi, the width of collecting system, the CT value and number of calculi, and with or without difficult access of ureteroscope (P<0.05). However, the presence of difficult access for the ureteroscope to reach the calculi was an independent influencing factor on the success, which was negatively correlated with the success of one-stage lithotripsy (regression coefficient=-1.233, P<0.01). ConclusionThe high success rate of holmium laser lithotripsy under rigid ureteroscope for upper ureteral calculi could be achieved. Its efficacy was related to a variety of factors, and difficult access or not might be the main influence factor. Rigid ureteroscopic holmium laser lithotripsy is still an ideal choice for minimally invasive surgical treatment for upper ureteral calculi.