术前结石处输尿管壁最大厚度对输尿管嵌顿性结石发生及预后的预测

Predictive value of preoperative maximum thickness of ureteral wall for occurrence and prognosis of ureteral incarcerated calculi

目的:探讨结石处输尿管壁最大厚度在输尿管嵌顿性结石发生及预后预测价值.方法:回顾性分析2018年1月-2019年12月收治192例输尿管结石患者的临床资料,其中诊断为嵌顿性结石80例设为A组,诊断为非嵌顿性结石112例设为B组;比较两组术前基线临床资料特征,采用Logistic回归模型分析输尿管嵌顿性结石术前独立预测因素,同时描绘ROC曲线评价术前结石处输尿管壁最大厚度预测价值.结果:①两组合并高血压情况、既往同侧结石治疗史、合并肾积水情况、结石横径、结石最大横截面积、结石体积、结石CT值、输尿管壁最大厚度及肾区叩击痛程度比较差异有统计学意义(P<0.05);②Logistic回归模型多因素分析结果提示,术前结石处输尿管壁最大厚度是输尿管嵌顿性结石术前独立预测因素(P<0.05);③描绘ROC曲线,术前结石处输尿管壁最大厚度AUC为0.93(95%CI:0.86~0.96),最佳预测截断值为3.20 mm,敏感度和特异度分别为83.17%,87.93%;④预测为输尿管嵌顿性结石组患者输尿管水肿、息肉及狭窄发生率均显著高于非输尿管嵌顿性结石组(P<0.05);预测为输尿管嵌顿性结石组患者术后结石清除率显著低于非输尿管嵌顿性结石组(P<0.05).结论:术前结石处输尿管壁最大厚度可用于预测输尿管嵌顿性结石发生,其中结石处输尿管壁最大厚度≥3.20 mm者合并病变更为严重,结石清除率较低.

Objective:To investigate the clinical value of preoperative maximum thickness of ureteral wall in the prediction on occurrence and prognosis of ureteral incarcerated calculi.Methods:The clinical data of 192 patients with ureteral incarcerated calculi including 80 cases of ureteral incarcerated calculi(group A)and 112 cases without ureteral incarcerated calculi(group B)were retrospectively chosen in the period from January 2018 to December 2019.The baseline clinical data of two groups before operation were compared and the independent predictors of ureteral incarcerated calculi before operation were analyzed by logistic regression.Then ROC curve was drawn to evaluate the predictive value of the maximum thickness of ureteral wall in stone place before operation.Results:(1)There were significant differences in hypertension,previous history of ipsilateral stones,hydronephrosis,stone diameter,stone maximum cross-sectional area,stone volume,stone CT value,maximum thickness of ureter wall and percussion pain degree in renal area between two groups(P<0.05).(2)The results of logistic regression analysis showed that the maximum thickness of ureteral wall was the independent predictor of ureteral incarcerated calculi before operation(P<0.05).(3)The AUC by ROC curve of maximum thickness of ureteral wall was 0.93(95%CI:0.86-0.96),the best predicted cutoff value was 3.20 mm,the sensitivity and specificity were 83.17%and 87.93%,respectively.(4)The incidence of ureteral edema,polyp and stricture in predicted ureteral incarcerated calculi group was significantly higher than non-predicted ureteral incarcerated calculi group(P<0.05).The stone clearance rate in predicted ureteral incarcerated calculi group was significantly lower than in non-predicted ureteral incarcerated calculi group(P<0.05).Conclusion:The maximum thickness of the ureteral wall in stone place before operation can be used to predict the occurrence of ureteral incarcerated stone,in which the patients with maximum thickness of the ureteral wall≥3.20 mm possess more seriousness disease and the lower stone clearance rate.