输尿管壁厚度诊断输尿管结石嵌顿的临床研究
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摘要
目的:评估输尿管壁厚度(UWT)诊断输尿管嵌顿性结石的临床意义。方法:回顾性分析2015年6月～2017年12月在我院行输尿管镜碎石术(URSL)患者的临床资料,在CT图像测得输尿管结石停留处输尿管壁最大厚度,使用单变量及多元Logistics回归分析UWT诊断输尿管结石嵌顿的潜力,并采用ROC曲线评估其精确性及截点值,并评估UWT与术中及预后情况的相关性。结果:286例输尿管结石患者中有118例(41.26%)结石嵌顿,结石嵌顿组与非嵌顿组在患者年龄、族别、肾积水、结石横径及UWT方面比较差异有统计学意义(P<0.05),且族别、肾积水及UWT可作为结石嵌顿的独立诊断因子。ROC曲线所得UWT的诊断精确性为81.48%,截点值为2.98mm。UWT大者的输尿管病理改变的发生率增高,且手术时间、术中及术后并发症的发生率显著增高。结论:UWT可作为术前诊断结石嵌顿的有效指标,指导手术方案的制定,减少手术并发症的发生。
Objective:To evaluate the clinical significance of ureteral wall thickness(UWT)to predict the presence of impacted stones in patients with ureteral stones.Method:We retrospectively analyzed 286 patients with ureteral stones who underwent ureteroscopic lithotripsy(URSL)between June 2015 and December 2017.Maximum UWT at the stone site was measured from CT images.The potential of UWT as a predictor of impacted stones was assessed using univariate and multivariate logistic regression analysis.Receiver operating characteristic curve analysis was applied to evaluate its accuracy in predicting impacted stones and to determine the UWT cutoff value.Moreover,we evaluated the association between UWT and intraoperative URSL findings,as well as prognosis.Result:Of the 286 patients,118(41.26%)were diagnosed with impacted stones.The univariate analysis showed significant difference in age,race,hydronephrosis,stone diameter and UWT between patients with and without impacted stones,and the multivariate logistics regression analysis showed that race,hydronephrosis and UWT were independent predictors of impacted stones.The receiver operating characteristic analysis showed that 2.98 mm was the optimal cutoff value for UWT,with a predictive accuracy of 81.48%.High UWT were positively associated with the incidence of impaction,ureteral pathological changes and intraoperative and postoperative complications.Conclusion:UWT may be a useful preoperative parameter in counseling patients about their treatment options and decreasing the incidence of complications.
Objective:To evaluate the clinical significance of ureteral wall thickness(UWT)to predict the presence of impacted stones in patients with ureteral stones.Method:We retrospectively analyzed 286 patients with ureteral stones who underwent ureteroscopic lithotripsy(URSL)between June 2015 and December 2017.Maximum UWT at the stone site was measured from CT images.The potential of UWT as a predictor of impacted stones was assessed using univariate and multivariate logistic regression analysis.Receiver operating characteristic curve analysis was applied to evaluate its accuracy in predicting impacted stones and to determine the UWT cutoff value.Moreover,we evaluated the association between UWT and intraoperative URSL findings,as well as prognosis.Result:Of the 286 patients,118(41.26%)were diagnosed with impacted stones.The univariate analysis showed significant difference in age,race,hydronephrosis,stone diameter and UWT between patients with and without impacted stones,and the multivariate logistics regression analysis showed that race,hydronephrosis and UWT were independent predictors of impacted stones.The receiver operating characteristic analysis showed that 2.98 mm was the optimal cutoff value for UWT,with a predictive accuracy of 81.48%.High UWT were positively associated with the incidence of impaction,ureteral pathological changes and intraoperative and postoperative complications.Conclusion:UWT may be a useful preoperative parameter in counseling patients about their treatment options and decreasing the incidence of complications.
引文
1 Sarica K,Kafkasli A,Yazici,et al.Ureteral wall thickness at the impacted ureteral stone site:a critical predictor for success rates after SWL[J].Urolithiasis,2015,43(1):83-88.
2 Sahin C,Eryildirim B,Kafkasli A,et al.Predictive parameters for medical expulsive therapy in ureteral stones:a critical evaluation[J].Urolithiasis,2015,43(3):271-275.
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 Mugiya S,Ito T,Maruyama S,et al.Endoscopic features of impacted ureteral stones[J].J Urol,2004,171(1):89-91.
5 Leijte J A,Oddens J R,Lock T M.Holmium laser lithotripsy for ureteral calculi:predictive factors for complications and success[J].J Endourol,2008,22(2):257-260.
6 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.
7 Elibol O,Safak K Y,Buz A,et al.Radiological noninvasive assessment of ureteral stone impaction into the ureteric wall:A critical evaluation with objective radiological parameters[J].Investig Clin Urol,2017,58(5):339-345.
8 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.
9 Kim J W,Chae J Y,Kim J W.Computed tomographybased novel prediction model for the stone-free rate of ureteroscopic lithotripsy[J].Urolithiasis,2014,42(1):75-79.
2 Sahin C,Eryildirim B,Kafkasli A,et al.Predictive parameters for medical expulsive therapy in ureteral stones:a critical evaluation[J].Urolithiasis,2015,43(3):271-275.
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 Mugiya S,Ito T,Maruyama S,et al.Endoscopic features of impacted ureteral stones[J].J Urol,2004,171(1):89-91.
5 Leijte J A,Oddens J R,Lock T M.Holmium laser lithotripsy for ureteral calculi:predictive factors for complications and success[J].J Endourol,2008,22(2):257-260.
6 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.
7 Elibol O,Safak K Y,Buz A,et al.Radiological noninvasive assessment of ureteral stone impaction into the ureteric wall:A critical evaluation with objective radiological parameters[J].Investig Clin Urol,2017,58(5):339-345.
8 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.
9 Kim J W,Chae J Y,Kim J W.Computed tomographybased novel prediction model for the stone-free rate of ureteroscopic lithotripsy[J].Urolithiasis,2014,42(1):75-79.