冲击波碎石术中治疗深度与疗效的关系研究

Relationship between treatment depth and efficacy in the treatment of extracorporeal shock wave lithotripsy

目的:探讨输尿管结石冲击波碎石术(SWL)中的治疗深度与冲击剂量及疗效的关系。方法:输尿管结石患者932例,分为上中段输尿管组(A组)和下段输尿管组(B组),每组再按治疗深度范围分为连续性的三个亚组,比较各组治疗深度对SWL冲击剂量和疗效的影响;再以残石作为因变量,以组别、性别、年龄、病程、肾积水程度、结石大小、治疗深度、电压、冲击次数、复震为自变量拟合两分类Logistic回归模型,分析各因素对残石的影响。结果:单因素分析结果显示在A、B两组中,治疗深度与治疗电压、无石率、复震率、效率商、术后肾绞痛发生率均未发现存在统计学关联,但上中段输尿管组随着治疗深度的增加,冲击次数增加(P=0.016)。而Logistic回归分析结果显示随着治疗深度的增加,无石率有下降的趋势(P=0.049)。结论:治疗深度是SWL疗效的影响因素,提示缩短治疗深度可提高SWL效率。

Objective To investigate the relationship between treatment depth and dose as related to the efficacy in the treatment of ureteral calculus by extraeorporeal shock wave lithotripsy. Methods 932 cases of ureteral calculus were divided into two groups of the upper, middle ureter group （group A） arid lower ureter group （group B）, likewise, treatment depth were assigned to three serial subgroups： A1≤ 7 cm, A2 7 - 9 cm, A3 ≥ 9Cm,Bl ≤8.5 cm,B2 8.5 - 10.5 cm,B3 ≥ 10.5 cm.Understandably,the intensity of impact correlates with treatment distance.The residual stones was dependent variables, and group, gender, age, duration, degree of hydronephrosis, stone size,treatment depth,treatment voltage,numbers of shock and retreatment rate were independent variables. Associations between the variables were studied by Logistic regression model. Results The single-factor analysis showed that there was no statistical correlation between the treatment depth and any of the following factors： treatment voltage, stone free rate, retreatment rate, effectiveness quotient and the postoperative incidence of renal colic. However, in the group A, as the depth of treatment increased, numbers of shock were increased （P = 0.016）, and the results of Logistic regression analysis showed that stone free rate has a downward trend （P = 0.049）. That is, the greater the stone distance from the lithotriptor, the greater the intensity of shock （dose） required. Conclusion Reduction in treatment depth improves the efficacy of shock wave lithotripsy.