影响体外冲击波碎石效果的多因素分析

The multivariate logistic regression analysis in patients with extracorporeal shock wave lithotripsy

目的 分析多种因素对体外冲击波碎石（ESWL）效果的影响,为尿路结石患者选择适当的治疗方法提供依据.方法 随访我院2005年11月至2006年3月之间进行ESWL治疗的113例患者,其中31例随访丢失,参与统计分析共72例,包括液电27例和电磁波45例.应用Logistic多元线性回归方法进行统计学分析.结果 本组72例共ESWL治疗137次,随访2～12周,平均8周.其中41例（56.9%）结石完全粉碎排空,30例（41.7%）结石不完全粉碎,1例（1.4%）患者碎石失败转为开放手术.多元Logistic回归分析表明在各因素中,只有结石大小（X5）、结石位置（X6）、冲击波源（X8）对ESWL治疗效果具有统计学意义.碎石效果指数PI=16.13-3.20X5-1.31X6-3.31X8,PI越大,表示治疗成功的概率越大.结论 体外冲击波碎石对泌尿系结石的治疗是安全且有效的.分析表明,结石直径越小,位置越低,越易排出;在相同结石条件下液电冲击波较电磁波的碎石效果要好.我们的统计分析模型可以对特定性状的结石计算出其碎石治疗成功的概率,有利于根据患者的具体情况在临床选择个体化的治疗方案.

Purpose To study the multiple factors that affect the result of extracorporeal shock wave lithotripsy （ESWL） and to set up a model to predict the outcome of the treatment of ESWL in patients with urinary calculi in different conditions. Methods We followed up 72 patients who received the treatment of ESWL from Nov. 2005 to April of 2006 in our hospital. Logistic multivariate regression analysis was performed on the patients＇ data and the results of the treatment. Results The patients were treated with ESWL in different shock wave including electrohydraulic （27 cases） and electromagnetic （45 cases） respectively. Forty-one cases （56.9%） were stone free after the treatment, while 30 cases （41.7%） had residual stones after ESWL, 1case was performed operation in the last for the failure of ESWL. During the follow up, 7 cases （9.7%） had side reaction including hematuria, fever, low back pain, hematochezia and so on, which needed emergent treatment. Twenty-seven cases （37.5%） developed transient hematuria and low back pain without special treatment. Logistic multivariate regression analysis identified the size and the location of the stone and the shock wave source as the independent predictors of stone-free status after ESWL. We set up an exponential model： PI = 16. 12552 - 3. 20179X5- 1. 30885X6- 3.31232X8,in which X5, X6, X8 represented the size of the stone, the location of the stone and the shock wave source respectively. Conclusions ESWL is safe and effective for most patients with urinary calculi, the smaller and the lower the stone, the higher possibility to get stone free. In our data, the electrohydraulic wave seems to have a better outcome after ESWL.