影响体外冲击波碎石治疗输尿管结石疗效的相关因素分析

Analysis of related factors affecting the curative effect of extracorporeal shock wave lithotripsy in the treatment of ureteral calculus

目的:探讨影响体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)治疗输尿管结石(ureteral calculus,UC)疗效的相关因素分析。方法:抽选2010年5月至2014年1月在我院行ESWL治疗的386例UC患者,碎石失败79例,作为碎石失败组;采用单因素分析碎石失败的影响因素,对P<0.05的相关因素再予以logistic回归分析。结果:经单因素分析显示,结石直径及位置、病程、肾积水程度、结石嵌顿和术后予以坦索罗辛等因素在碎石成功与失败两组患者间的比较具有显著性差异(P<0.05)。经logistic回归分析显示,结石直径超过10 cm、中下段UC、服用坦索罗辛、病程>3个月、结石嵌顿等因素是影响CC碎石失败的独立危险因素(OR=1.897,P=0.033;OR=2.569,P=0.023;OR=1.676,P=0.042;OR=2.387,P=0.011;OR=2.433,P=0.015)。结论:对于结石较大、中下段UC、病程>3个月、结石嵌顿的UC患者,行ESWL后较易发生狭窄,在治疗上应更加慎重,术后采用坦索罗辛口服具有保护性作用,值得临床借鉴推广。

Objective：To analyze the related factors affecting the curative effect of extracorporeal shock wave lithotripsy （ ES-WL） in the treatment of ureteral calculus（ UC） . Methods：386 cases of patients with UC treated with ESWL in our hospital from May 2010 to January 2014 were selected. 79 cases of patients were treated with ESWL but the treatment failure,which were called lithotripsy failure group. The influencing factors of lithotripsy failure were analyzed using univariate analysis and logistic regression analysis was used to identify the related factors of P-value less than 0. 05. Results：The univariate analysis showed that the differences of calculus di-ameter and location,course of disease,degree of hydronephrosis,calculus incarcerated and Tamsulosin given in the treatment after oper-ation between the two groups had significant differences in success and failure of the treatment（P〈0. 05）. The logical regression analy-sis showed that the calculus diameter which was more than 10 cm,lower segment of the UC,taking Tamsulosin,the course of disease for more than 3 months,calculus incarceration were independent risk factors of lithotripsy failures for ureteral calculi（ OR=1. 879,P=0. 033;OR=2. 569,P=0. 042;OR=1. 676,P=0. 042;OR=2. 387,P=0. 011;OR=2. 433,P=0. 015）. Conclusion：For the patients with larger stones,the lower segment of the UC,the course of disease for more than 3 months and stone incarceration in ureter,uretero-stenosis is likely to happen after using the treatment of ESWL,so the treatment should be more careful. Taking oral Tamsulosin after op-eration has a protective effect. This method is worthy of clinical reference and promotion.