输尿管软镜治疗肾结石手术时间的影响因素分析

Analysis of influencing factors of flexible ureteroscopy in the treatment of renal stones

目的探讨输尿管软镜治疗肾结石手术时间的影响因素。方法搜集河北北方学院附属第一医院2013年12月~2017年12月行输尿管软镜碎石术(FURL)患者202例,均采用科医人钬激光碎石,术后3个月复查平扫CT后151例无残石,按手术时间分为两组,>90 min组(44例)和≤90 min组(107例)。手术时间分为3个时期:总时间、碎石开始前和碎石开始后。对可能影响手术时间的因素进行多元性逻辑回归模型分析。结果平均手术时间为(79.0±31.0)min,影响手术时间的主要因素包括结石体积、最大和平均CT值、软镜鞘的直径和外科医生经验。患者总手术时间及FURL后手术时间的多变量评估显示,结石体积(P <0.01)、外科医生的经验(P <0.01)、最大CT值(P <0.05)和术前支架置入术(P <0.05)与总手术时间及FURS开始后手术时间相关,而FURS开始前时间与各个临床因素无关(P> 0.05)。结论结石体积、CT值、外科医生手术经验、术前放置D-J管是影响碎石后的时间及总手术时间的主要因素,而碎石前的时间的影响因素很难预测。

Objective To investigate the clinical factors affecting the time of flexible ureteroscopy for the treatment of renal stones. Methods From December 2013 to December 2017, 202 patients from the First Affiliated Hospital of Hebei North University with flexible ureteroscope lithotripsy(FURL) were selected, all of them were treated with laser lithotripsy of medical doctors, 151 of them without residual stones reviewed by plain scan CT after 3 months of the operation, the patients were divided into two groups by the operation time,>90 min group(44 cases) and ≤90 min group(107 cases). The operation time was divided into three periods: total time, pre-crushing, post-crushing. The multivariate Logistic regression model analysis was used for the factors that may affect the operation time. Results The average operation time was(79.0±31.0) min. The main factors affecting operation time included stone volume, maximum and mean CT values, diameter of the soft sheath, and experiences of the doctor. Multivariate evaluation of total operation time and post-crushing time, showed that there relationships with stones volume(P < 0.01), experiences of doctor(P < 0.01),maximum CT value(P < 0.05), preoperative stenting(P < 0.05) and total operation time and post-crushing time. However, the time before the start of lithotripsy was not correlated with any clinical factors(P > 0.05). Conclusion The volume of stone, CT value, experience of the doctor, placeing a D-J tube before the operation are the main factors influce the total operation time and post-crushing time, and the time before the crushing stone is difficult to predict.