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体外冲击波碎石术治疗输尿管结石的疗效预测

Prediction of outcome of extracorporeal shock wave lithotripsy in the management of ureteric calculi.

作者信息

Wang Mingqing, Shi Qiduo, Wang Xuguang, Yang Kun, Yang Rui

机构信息

Centre of Urology, Nankai Hospital, Tianjin, 300100, People's Republic of China.

出版信息

Urol Res. 2011 Feb;39(1):51-7. doi: 10.1007/s00240-010-0274-5. Epub 2010 Apr 18.

Abstract

The present study was designed to evaluate the clinical outcome of using extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi and to establish a predictive model for the stone-free rate in patients receiving the treatment. A total of 831 patients with ureteric calculi were accepted in this study. Several parameters, including stone site, stone number, stone size, history of urolithiasis, renal colic, hydronephrosis, and double-J ureteric stent, were analyzed using univariate and multivariate analyses. A prediction model was established based on the logistic regression analysis of the significant factors, and the goodness-of-fit of the model was evaluated by employing the Hosmer-Lemeshow test. At a 3-month follow-up after ESWL treatment, the overall stone-free rate was 96.8% (804/831) with no serious complications being found, while the treatment failed in 3.2% (27/831) of the patients. Five factors, including stone number, stone size, history of urolithiasis, renal colic, and double-J ureteric stent contributed significantly to the clinical outcome of the ESWL treatment. The prediction model had a sensitivity and overall accuracy of 99.8 and 96.9%, respectively. The results show that ESWL remains an effective method for treating ureteric calculi. The prediction model established in this study could be used as a method for estimating prognosis in patients following ESWL treatment.

摘要

本研究旨在评估体外冲击波碎石术(ESWL)治疗输尿管结石的临床疗效,并建立接受该治疗患者结石清除率的预测模型。本研究共纳入831例输尿管结石患者。使用单因素和多因素分析方法,对包括结石部位、结石数量、结石大小、尿路结石病史、肾绞痛、肾积水和双J输尿管支架等多个参数进行了分析。基于对显著因素的逻辑回归分析建立了预测模型,并采用Hosmer-Lemeshow检验评估模型的拟合优度。ESWL治疗后3个月随访时,总体结石清除率为96.8%(804/831),未发现严重并发症,而3.2%(27/831)的患者治疗失败。结石数量、结石大小、尿路结石病史、肾绞痛和双J输尿管支架这五个因素对ESWL治疗的临床疗效有显著影响。该预测模型的敏感度和总体准确率分别为99.8%和96.9%。结果表明,ESWL仍然是治疗输尿管结石的有效方法。本研究建立的预测模型可作为评估ESWL治疗后患者预后的一种方法。

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