输尿管软镜治疗小儿上尿路结石手术结局与体重指数的相关性分析

王小川; 张宇; 焦建伟; 田野; 李钧

doi:10.13201/j.issn.1001-1420.2021.03.009

输尿管软镜治疗小儿上尿路结石手术结局与体重指数的相关性分析

- 首都医科大学附属北京友谊医院泌尿外科(北京, 100050)

详细信息

通讯作者: 李钧,E-mail:lljun@yeah.net

中图分类号: R693

收稿日期: 2020-07-16

Influence of body mass index on the surgical outcomes of flexible ureteroscopy for pediatric upper urinary tract calculi

- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

More Information

Corresponding author: LI Jun, E-mail: lljun@yeah.net

Received Date: 16 July 2020

摘要

摘要: 目的:探讨输尿管软镜(FURS)治疗小儿上尿路结石手术结局与体重指数(BMI)之间的关系。方法:本文回顾性分析我院2014年6月—2019年4月前瞻性构建的儿童结石数据库中的病例。计算患儿BMI值并根据疾病控制和预防中心(CDC)的BMI性别年龄增长图描记每位患儿BMI百分位数。根据BMI百分位数将患儿分为三组:较高体重百分位数组(UBW组)、正常体重百分位数组(NBW组)和较低的体重百分位数组(LBW组)。计量资料以中位数和四分位间距表示,计数资料以频数和百分数表示。通过Wilcoxon秩和检验和卡方检验比对不同BMI百分位数组患儿的基本特征、结石特征、手术数据及手术结局等资料之间的差异。应用学习曲线评估手术医生的经验在不同BMI儿童人群分层中对手术结局的影响。手术结局包括结石清除率(SFR)和术后并发症发生率(CR)结果:根据纳入与排除标准,最终161例患儿进入研究队列,男114例,女47例。其中UBW组患儿63例(39.1%),NBW组患儿64例(39.8%),LBW组患儿34例(21.1%)。三组患儿的中位结石负荷分别为1.14 cm²(IQR 0.50~3.41 cm²)、1.13 cm²(IQR 0.70~3.14 cm²)和0.95 cm²(IQR 0.50~1.77 cm²),差异无统计学意义(P=0.17)。三组患儿的SFR分别为90.5%、81.3%和70.6%,差异有统计学意义(P=0.04),CR分别为15.9%、21.9%和29.4%,差异无统计学意义(P=0.29)。学习曲线表明,手术医师在经过大约100例FURS的学习后,SFR可以得到明显改善。LBW组患儿病例使手术医师的学习难度有所提高。结论:儿童BMI与FURS治疗小儿上尿路结石术后SFR相关,LBW组患儿SFR较低。低BMI患儿使FURS的学习更具挑战性。
- 儿童尿石症 /
- 输尿管软镜 /
- 体重指数 /
- 手术结局 /
- 学习曲线
Abstract: Objective: To examine the association between body mass index(BMI) and surgical outcomes of flexible ureteroscopy(FURS) for pediatric upper urinary tract calculi.Methods: We reviewed our prospectively maintained database containing children who had kidney or ureteral stones from June 2014 to April 2019. We calculated BMI and plotted it on the Centers for Disease Control and Prevention(CDC) growth chart for sex and age to estimate BMI percentile. Children were stratified into 3 BMI categories according to CDC age adjusted BMI percentiles for children, including lower body weight percentile(LBW), normal body weight percentile(NBW) and upper body weight percentile(UBW). Numerical variables and categorical variables were represented with median(interquartile range) and number(percentile). Wilcoxon rank sum tests and Chi-square tests were performed to compare the difference of patient demographics, intraoperative data, stone characteristics and surgical outcomes among different cohorts of BMI percentile. Surgical outcomes consisted of stone-free rate(SFR) and complication rate(CR). Learning curves were generated to estimate the effect of the surgeon's experience on surgical outcomes.Results: The final analysis included 161 children, of whom 114 were male and 47 were female. Sixty-three(39.1%) children were categorized into UBW cohort, while 64(39.8%) and 34(21.1%) were categorized into NBW and LBW respectively. The median stone burden of the three groups were 1.14 cm²(IQR 0.50-3.41 cm²), 1.13 cm²(IQR 0.70-3.14 cm²) and 0.95 cm²(IQR 0.50-1.77 cm²), respectively(P=0.17). SFRs were 90.5%(57/63), 81.3%(52/64) and 70.6%(24/34), respectively(P=0.04). CRs were 15.9%(10/63), 21.9%(14/64) and 29.4%(10/34), respectively(P=0.29). The learning curves showed that SFR of FURS could be improved after about 100 cases. And decreasing BMI could steepen the learning curve.Conclusion: BMI is associated with SFR of FURS. LBW children had the lowest SFR compared to UBW and NBW children. Decreasing BMI makes the success of FURS more challenging.
- pediatric urolithiasis /
- flexible ureteroscopy /
- body mass index /
- surgical outcome /
- learning curve

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参考文献(24)

[1]	Abarca-Gómez L,Abdeen ZA,Hamid ZA,et al.Worldwide trends in body-mass index,underweight,overweight,and obesity from 1975 to 2016:a pooled analysis of 2416 population-based measurement studies in 128·9 million children,adolescents,and adults[J].Lancet,2017,390(10113):2627-2642.
[2]	Dwyer ME,Krambeck AE,Bergstralh EJ,et al.Temporal trends in incidence of kidney stones among children:a 25-year population based study[J].J Urol,2012,188(1):247-252.
[3]	Ward JB,Feinstein L,Pierce C,et al.Pediatric Urinary Stone Disease in the United States:The Urologic Diseases in America Project[J].Urology,2019,129:180-187.
[4]	卢穗琳,段海峰,朱玮,等.超微经皮肾镜取石术治疗儿童上尿路结石的疗效评估[J].临床泌尿外科杂志,2019,34(3):173-175.
[5]	Eric NT,Meir JS,Gary CC.Obesity,Weight Gain,and the Risk of Kidney Stones[J].JAMA,2005,293:455-462.
[6]	Eisner BH,Eisenberg ML,Stoller ML.Influence of body mass index on quantitative 24-hour urine chemistry studies in children with nephrolithiasis[J].J Urol,2009,182(3):1142-1145.
[7]	Lee SC,Kim YJ,Kim TH,et al.Impact of obesity in patients with urolithiasis and its prognostic usefulness in stone recurrence[J].J Urol,2008,179(2):570-574.
[8]	Sorensen MD,Kahn AJ,Reiner AP,et al.Impact of nutritional factors on incident kidney stone formation:a report from the WHI OS[J].J Urol,2012,187(5):1645-1649.
[9]	Kieran K,Giel DW,Morris BJ,et al.Pediatric urolithiasis--does body mass index influence stone presentation and treatment?[J].J Urol,2010,184(4 Suppl):1810-1815.
[10]	Alfandary H,Haskin O,Davidovits M,et al.Increasing Prevalence of Nephrolithiasis in Association with Increased Body Mass Index in Children:A Population Based Study[J].J Urol,2018,199(4):1044-1049.
[11]	王磊,王文营,张彩祥,等.输尿管软镜和Microperc治疗婴幼儿≤2 cm肾结石的疗效比较[J].临床泌尿外科杂志,2019,34(4):259-263.
[12]	Bayne DB,Usawachintachit M,Tzou D,et al.Increasing Body Mass Index Steepens the Learning Curve for Ultrasound-guided Percutaneous Nephrolithotomy[J].Urology,2018,120:68-73.
[13]	Fuller A,Razvi H,Denstedt JD,et al.The CROES percutaneous nephrolithotomy global study:the influence of body mass index on outcome[J].J Urol,2012,188(1):138-144.
[14]	Omar M,Noble M,Sivalingam S,et al.Systemic Inflammatory Response Syndrome after Percutaneous Nephrolithotomy:A Randomized Single-Blind Clinical Trial Evaluating the Impact of Irrigation Pressure[J].J Urol,2016,196(1):109-114.
[15]	Giusti G,Proietti S,Rodríguez-Socarrás ME,et al.Simultaneous Bilateral Endoscopic Surgery(SBES)for Patients with Bilateral Upper Tract Urolithiasis:Technique and Outcomes[J].Eur Urol,2018,74(6):810-815.
[16]	Tiselius H.Stone Burden in an Average Swedish Population of Stone Formers Requiring Active Stone Removal:How Can the Stone Size Be Estimated in the Clinical Routine?[J].Eur Urol,2003,43(3):275-281.
[17]	Kurtz MP,McNamara ER,Schaeffer AJ,et al.Association of BMI and pediatric urologic postoperative events:Results from pediatric NSQIP[J].J PediatrUrol,2015,11(4):224 e1-e6.
[18]	Sen H,Seckiner I,Bayrak O,et al.A comparison of micro-PERC and retrograde intrarenal surgery results in pediatric patients with renal stones[J].J Pediatr Urol,2017,13(6):619 e1-619 e5.
[19]	Pelit ES,Atis G,Kati B,et al.Comparison of Mini-percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Preschool-aged Children[J].Urology,2017,101:21-25.
[20]	Castro EP,Osther PJ,Jinga V,et al.Differences in ureteroscopic stone treatment and outcomes for distal,mid-,proximal,or multiple ureteral locations:the Clinical Research Office of the Endourological Society ureteroscopy global study[J].Eur Urol,2014,66(1):102-109.
[21]	Schott F,Knipper S,Orywal AK,et al.Effect of the body mass index on outcomes of ureterorenoscopy for renal stones[J].Urologe A,2016,55(11):1462-1469.
[22]	Laclergerie F,Jacquemet B,Guichard G,et al.Flexible ureterorenoscopy in obese patients:results from a large monocenter cohort[J].Prog Urol,2014,24(10):634-639.
[23]	Pompeo A,Molina WR,Juliano C,et al.Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance(SSD)in obese and morbid patients[J].Int Braz J Urol,2013,39(5):702-709;discussion 710-711.
[24]	Hsi RS,Sanford T,Goldfarb DS,et al.The Role of the 24-Hour Urine Collection in the Prevention of Kidney Stone Recurrence[J].J Urol,2017,197(4):1084-1089.