输尿管软镜碎石治疗肾结石患者清石率及多因素logistic回归分析研究

目的研究输尿管软镜碎石(FURL)治疗肾结石患者清石率情况并进行多因素logistic回归分析。方法选择2016年12月至2017年12月于本院治疗的216例肾结石患者为研究对象,所有患者均采用经输尿管软镜钬激光碎石治疗,术后1周进行尿路平片(KUB)复查,根据是否存在结石残留分为残留组与无残留组,调查两组患者性别、年龄、结石情况等病历资料,组间进行单因素、多因素logistic回归分析确定FURL治疗肾结石患者清石率的独立影响因素。结果216例肾结石患者结石残留40例,结石残留率18.52%,清石率81.48%。两组术前尿路感染、结石直径、合并肾功能不全、肾盏夹角、结石脓苔包裹、术中出血、结石数量、手术时间、结石位置差异具有统计学意义(P<0.05),组间年龄、性别、合并肾积水、合并糖尿病差异无统计学意义(P>0.05);多因素logistic回归分析结果显示术前尿路感染(OR=2.743,95%CI:1.043~7.316)、结石直径>4 cm(OR=3.654,95%CI:1.211~10.642)、合并肾功能不全(OR=3.032,95%CI:1.132~9.766)、肾盏夹角<30°(OR=3.887,95%CI:1.321~11.598)、结石脓苔包裹(OR=3.221,95%CI:1.187~9.879)是FURL治疗肾结石患者清石率的独立影响因素。结论FURL治疗肾结石具有一定的结石残留情况,术前尿路感染、结石直径>4 cm、合并肾功能不全、肾盏夹角<30°、结石脓苔包裹均可增加结石残留风险,影响手术清石率。

Clear stone rate and multivariate logistic regression analysis of flexible ureteroscopic lithotripsy in the treatment of patients with kidney stones

Objective To study the clear stone rate and multivariate logistic regression analysis of flexible ureteroscopic lithotripsy(FURL)in the treatment of patients with kidney stone.Methods A total of 216 patients with kidney stones treated in our hospital from December 2016 to December 2017 were included in the study.All patients underwent ureteroscopic holmium laser lithotripsy.One week after surgery,kidney ureter bladder(KUB)review was performed.According to whether there are residual stones,they were divided into the residual group and the non-residue group.The gender,age,stone and other medical records of the two groups of patients were investigated.Single-factor and multi-factor logistic regression analysis were performed to determine the independent factors of FURL in the treatment of clear stone rate in patients with kidney stones.Results In 216 patients with kidney stones,40 patients had residual stones,the residual rate of stones was 18.52%,and the rate of clear stone was 81.48%.There were significant differences in preoperative urinary tract infection,stone diameter,renal insufficiency,renal pelvic angle,calculus envelopment,intraoperative bleeding,number of stones,operation time,and stone position(P<0.05).There was no significant difference in age,gender,hydronephrosis,and diabetes mellitus(P>0.05).Multivariate logistic regression analysis showed preoperative urinary tract infection(OR=2.743,95%CI:1.043-7.316),stones Diameter>4 cm(OR=3.654,95%CI:1.211-10.642),combined with renal insufficiency(OR=3.032,95%CI:1.132-9.766),angle of renal pelvis<30°(OR=3.887,95%CI:1.321-11.598)and stone pus moss wrap(OR=3.221,95%CI:1.187-9.879)were the independent influencing factor of FURL in the treatment of patients with kidney stones.Conclusions FURL treatment of kidney stones with certain stone residual conditions,preoperative urinary tract infection,stone diameter>4 cm,combined with renal insufficiency,renal pelvic angle<30°,stone pus coating can increase the risk of stone residual,affecting surgery clear stone rate.