输尿管壁面积对输尿管嵌顿性结石的预测价值

冯才鑫; 邱晓拂; 陈波特; 王炳卫; 张涛; 林康健; 廖俊发; 黎忠大; 林峥; 杨国胜

doi:10.13201/j.issn.1001-1420.2021.03.008

输尿管壁面积对输尿管嵌顿性结石的预测价值

- 1. 广东医科大学(广东湛江, 524023);
- 2. 广东省第二人民医院泌尿外科;
- 3. 同济大学附属东方医院泌尿外科

详细信息

通讯作者: 杨国胜,E-mail:2008yangguosheng@sina.com

中图分类号: R693

收稿日期: 2020-08-31

Predictive value of ureteral wall area for impacted ureteral stones

- 1. Guangdong Medical University, Zhanjiang, Guangdong, 524023, China;
- 2. Department of Urology, Guangdong Second Provincial General Hospital;
- 3. Department of Urology, Shanghai East Hospital, Tongji University School of Medicine

More Information

Corresponding author: YANG Guosheng, E-mail: 2008yangguosheng@sina.com

Received Date: 31 August 2020

摘要

摘要: 目的:探讨输尿管壁面积(UWA)对输尿管嵌顿性结石的预测价值。方法:回顾性分析我院2019年2月—2020年8月215例因输尿管结石行输尿管镜碎石术患者的临床资料,根据结石是否嵌顿分为嵌顿组和非嵌顿组,纳入数据包括性别、年龄、病程、高血压、糖尿病、患侧、结石位置、血白细胞计数、C反应蛋白、肌酐、尿白细胞计数、结石长度、结石宽度、肾盂分离宽度、结石面积、输尿管壁厚度(UWT)、UWA,先采用单因素分析和多因素Logistics分析确定嵌顿性结石的独立预测因素,再绘制受试者工作特征曲线(ROC)并评估独立预测因素的预测价值。结果:215例单发输尿管结石中有76例(35.35%)为嵌顿性结石,单因素分析结果显示两组性别、年龄、病程、高血压病、糖尿病、患侧、结石位置、血白细胞计数、C反应蛋白、尿白细胞计数、结石长度比较差异无统计学意义(P＞0.05),肌酐、肾盂分离宽度、结石宽度、结石面积、UWT、UWA比较差异有统计学差异(P＜0.05),多因素Logistics分析结果显示肌酐、肾盂分离宽度、结石宽度、结石面积比较差异无统计学意义(P＞0.05),UWT、UWA是输尿管嵌顿性结石的独立预测因素(P＜0.001),ROC曲线分析结果显示UWT的ROC曲线下面积值为0.867,界值为3.95 mm,敏感性为73.7%,特异性为84.9%,UWA的ROC曲线下面积值为0.902,界值为74.50 mm²,敏感性为76.3%,特异性为97.1%。结论:相较于UWT,UWA对输尿管嵌顿性结石具有更好的预测价值。
- 输尿管壁面积 /
- 嵌顿性输尿管结石 /
- 预测价值
Abstract: Objective: To evaluate the predictive value of ureteral wall area(UWA) for impacted ureteral stones.Methods: We retrospectively analyed clinical data of 215 patients with ureteral stones performed ureteroscopic lithotripsy between February 2019 and August 2020. Patients were divided into impacted group and unimpacted group according to whether stones were impacted. Gender, age, course of the disease, hypertension, diabetes, stone side, stone location, blood leukocyte count, c-reactive protein, creatinine, urine leukocyte count, length of stone, width of stone, width of pelvis separation, area of stone, ureteral wall thickness(UWT) and UWA were recorded. Firstly, we determined the factors that could predict the stone impaction in univariate analysis and multivariate logistic regression analysis. Then the receiver operating characteristic(ROC) curve analysis was applied to evaluate the predictive value of the independent predictors.Results: Of the 215 patient, 76(35.35%) were ureteral impacted stones.Resultsof univariate analysis showed that gender, age, course of the disease, hypertension, diabetes, stone side, stone location, blood leukocyte count, c-reactive protein, urine leukocyte count, length of stone showed no significant difference(P＞0.05). Creatinine, width of stone, width of pelvis separation, area of stone, UWT and UWA showed significant difference(P＜0.05).Resultsof multivariate logistic regression analysis showed that there was no significant difference in creatinine, width of pelvis separation, width of stone or area of stone(P＞0.05). UWT and UWA were the independent predictors of ureteral impacted stones(P＜0.001). The ROC curve analysis results showed that the area under the ROC curve of UWT was 0.867, and the optimal cut-off value was 3.95 mm. The sensitivity was 73.7%, and the specificity was 84.9%. The area under the ROC curve of UWA was 0.902, and the optimal cut-off value was 74.50 mm². The sensitivity was 76.3%, and the specificity was 97.1%.Conclusion: Compared with UWT, UWA has better predictive value for ureteral impacted stones.
- ureteral wall area /
- impacted ureteral stones /
- predictive value

HTML全文

参考文献(13)

[1]	Mugiya S,Ito T,Maruyama S,et al.Endoscopic features of impacted ureteral stones[J].J Urol,2004,171(1):89-91.
[2]	Deng T,Chen Y,Liu B,et al.Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones[J].World J Urol,2019,37(8):1687-1701.
[3]	Deliveliotis C,Chrisofos M,Albanis S,et al.Management and follow-up of impacted ureteral stones[J].Urol Int,2003,70(4):269-272.
[4]	Sarica K,Eryildirim B,Sahin C,et al.Impaction of ureteral stones into the ureteral wall:Is it possible to predict?[J].Urolithiasis,2016,44(4):371-376.
[5]	Yoshida T,Inoue T,Omura N,et al.Ureteral Wall Thickness as a Preoperative Indicator of Impacted Stones in Patients With Ureteral Stones Undergoing Ureteroscopic Lithotripsy[J].Urology,2017,106:45-49.
[6]	Chandhoke R,Bamberger JN,Gallante B,et al.Peri-Calculus Ureteral Thickness on Computed Tomography Predicts Stone Impaction at Time of Surgery:A Prospective Study[J].J Endourol,2020,34(1):107-111.
[7]	Ozbir S,Can O,Atalay HA,et al.Formula for predicting the impaction of ureteral stones[J].Urolithiasis,2020,48(4):353-360.
[8]	Legemate JD,Wijnstok NJ,Matsuda T,et al.Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones[J].World J Urol,2017,35(10):1497-1506.
[9]	Mugiya S,Ito T,Maruyama S,et al.Endoscopic features of impacted ureteral stones[J].J Urol,2004,171(1):89-91.
[10]	刘彼得,李循,文彬,等.输尿管壁厚度诊断输尿管结石嵌顿的临床研究[J].临床泌尿外科杂志,2019,34(3):176-179.
[11]	Yamashita S,Kohjimoto Y,Iguchi T,et al.Ureteral wall volume at ureteral stone site is a critical predictor for shock wave lithotripsy outcomes:comparison with ureteral wall thickness and area[J].Urolithiasis,2020,48(4):361-368.
[12]	王成路,金露,薛波新.术前预测输尿管嵌顿性结石的临床因素分析[J].中华泌尿外科杂志,2019,40(1):42-46.
[13]	Yoshida T,Inoue T,Taguchi M,et al.Ureteral wall thickness as a significant factor in predicting spontaneous passage of ureteral stones of ≤10 mm:a preliminary report[J].World J Urol,2019,37(5):913-919.