输尿管软镜钬激光碎石术治疗输尿管上段复杂性结石后双J管附壁结石形成的原因分析

Analysis of the reasons for the formation of double J tube wall attached stones after ureteroscopic holmium laser lithotripsy for the treatment of complex upper ureteral stones

目的:分析输尿管软镜钬激光碎石术治疗输尿管上段复杂性结石后双J管附壁结石形成的原因。方法:选择2015年1月至2023年8月于首都医科大学附属北京潞河医院收治的105例输尿管上段复杂性结石患者,其中男58例,女47例,根据结石评估结果分为结石组(n=40)与非结石组(n=65)。通过随机森林算法分析患者双J管附壁结石形成的影响因素。通过单因素和多因素分析双J管附壁结石形成的独立影响因素,并构建分类树模型。结果:结石组和非结石组CT值、术中出血量、双J管留置时间、白细胞计数(WBC)、C反应蛋白(CRP)、尿酸(UA)、血钙、尿pH值、尿蛋白、尿红细胞、尿白细胞、尿结晶比较差异均有统计学意义(t/χ^(2)值分别为4.361、2.502、6.815、12.176、24.398、15.595、6.517、2.069、6.881、4.524、3.883、4.699,均P<0.05)。双J管留置时间、尿蛋白阳性、尿结晶阳性、UA为双J管附壁结石形成的独立危险因素(P<0.05)。分类树模型显示,双J管留置时间是双J管附壁结石形成的重要预测因素,收益图和索引图显示模型预测良好。结论:双J管留置时间、尿蛋白阳性、尿结晶阳性、UA为双J管附壁结石形成的独立危险因素。临床应重点关注相关因素,及时制定预防策略,以期降低双J管附壁结石的发生风险。

Objective:To analyze the causes of encrustation formation on double-J stents after flexible ureteroscopy with holmium lase lithotripsy for the treatment of upper ureteral complex stones.Methods:105 patients with complex upper ureteral stones admitted to Beijing Luhe Hospital Affiliated to Capital Medical University from January 2015 to August 2023 were selected,including 58 males and 47 females.According to the evaluation results of the stones,they were divided into stone group(n=40)and no stone group(n=65).Analyze the influencing factors of the formation of double J tube wall attached stones in patients using the random forest algorithm.Analyze the independent influencing factors of the formation of double J tube wall attached stones through single factor and multiple factor analysis,and construct a classification tree model.Results:There were statistically significant differences between the stone group and the non stone group in CT values,intraoperative blood loss,double J tube retention time,white blood cell count(WBC),C-reactive protein(CRP),uric acid(UA),blood calcium,urine pH,urine protein,urine red blood cells,urine white blood cells,and urine crystallization(t/χ^(2)=4.361,2.502,6.815,12.176,24.398,15.595,6.517,2.069,6.881,4.524,3.883,4.699,respectively,all P<0.05).The duration of double J tube retention,positive urine protein,positive urine crystallization,and UA were independent risk factors for the formation of double J tube wall attached stones(P<0.05).The classification tree model showed that the retention time of double J tubes was an important predictive factor for the formation of double J tube wall attached stones,and the profit and index charts showed that the model predicts well.Conclusion:The duration of double J tube retention,positive urine protein,positive urine crystallization,and UA are independent risk factors for the formation of double J tube wall attached stones.Clinical attention should be paid to relevant factors and timely prevention strategies should be formulated to reduce the risk of double J tube wall attached stones.