输尿管结石患者ESWL成功率与KUB中放射学参数之间关系及其预测因子的分析

Analysis of the relationship between ESWL success rate and radiology parameters in KUB and predictors of ESWL success rate in patients with ureteral calculi

目的:探讨X线平片(肾-输尿管-膀胱,KUB)中输尿管结石的影像学参数与体外冲击波碎石(ESWL)成功率之间的关系。方法:本研究包括446例有影像学证据的输尿管结石并经ESWL治疗患者。ESWL之前进行血常规及尿常规分析、X线平片(KUB)及非强化CT平扫检查(NCCT)。根据KUB中影像学参数将所有患者分成两组:低密度(LD)组(结石密度低于或等于第12肋)和高密度(HD)组(结石密度高于第12肋)。ESWL后每周进行KUB检查对结石状态进行评估。ESWL后4周内结石消失被定义为治疗成功。对患者的临床资料、KUB及NCCT中结石参数、ESWL成功率进行比较,并分析ESWL成功率的预测因子。结果:LD组包括326例患者,HD组包括120例患者。结石的平均大小在LD组(7.33±1.25mm)中显著低于HD组(9.75±2.84mm)(P<0.05)。EWSL成功率在LD组及HD组分别为81.6%和59.2%(P<0.05)。ESWL平均次数分别为LD组(1.7±1.3)次,HD组(2.4±1.4)次(P<0.05)。应用多变量logistic回归分析显示,结石大小、绞痛发作开始到ESWL时间及KUB上结石密度是ESWL成功的单独预测指标。结论:以KUB中结石密度分组比较显示,两组在ESWL成功率中差异有统计学意义,且我们的数据指出较大的结石、发病距离ESWL时间较长及输尿管结石密度高于第12肋可能是ESWL失败的相关因素。本研究为以KUB作为临床手段预测ESWL成功率提供了证据,并在临床实践中对结石病预后评估与治疗方式选择有一定的指导意义。

Objective：To explore the relationship between the imaging parameters in X-ray plain film of KUB（kidney-ureter-bladder）and the success rate of extracorporeal shock wave lithotripsy（ESWL）in patients with ureteral calculi.Method：This study included 446 patients with radiographic evidence of patients with ureteral calculi who were treated with ESWL.Before ESWL the data of routine blood and urine analysis,X-ray plain film of KUB and the CT scan（NCCT）were gathered.All of the patients were divided into two groups according to the imaging parameters in KUB,low density（LD）group（stone density less than or equal to 12 th rib）and high density（HD）group（calculi density higher than the 12 th rib）.KUB was performed weekly after ESWL to evaluate calculi state.It was defined as a successful treatment if stone disappeared within four weeks after ESWL.The clinical data of patients,calculi parameters in KUB and in NCCT and the ESWL success rate were compared,and the predictors of success rate of ESWL were analyzed.Result：The LD group included 326 patients,while the HD group included 120 patients.The average size of stone in the group of LD was significantly lower than that in HD（7.33±1.25 mm vs.9.75±2.84 mm,P〈0.05）.EWSL success rate in LD and HD group were 81.6%and 59.2% respectively（P〈0.05）.ESWL average frequency of LD group and the HD group were（1.7±1.3）times and（2.4±1.4）times respectively（P〈0.05）.The multivariate logistic analysis showed that the stone size,colic attacks to ESWL time and density on KUB calculi were independent predictors of success in ESWL.Conclusion：Stone of density in the KUB grouping comparison shows that two groups have significant difference in the success rate of ESWL,and our data point out that the larger stones,long time to ESWL,skin to stone distance and ureteral calculi density are related factors of ESWL success rate.This study provides evidence to predict ESWL success rate with KUB,and has certain guiding significance to evaluate the prognosis of urinary calculi and the choice of treatment in clinical practice.