输尿管壁厚度作为预测输尿管镜下治疗输尿管下段梗阻性结石的应用研究

The use of ureteral wall thickness for predicting the presence of distal ureter impacted stones in patients with ureteral stones undergoing ureteroscopic lithotripsy

目的通过测量输尿管壁厚度预测输尿管镜下治疗的输尿管下段结石是否为梗阻性结石。方法回顾性分析本院2014年2月至2018年2月共计320例接受输尿管镜手术的患者资料,通过高分辨CT平扫测量结石周围输尿管管壁厚度,通过ROC曲线分析输尿管管壁厚度,通过不同诊断分界点的灵敏度和特异度确定最佳诊断分界点。结果320例患者中,梗阻性结石的患者为119例,患者所患结石是否合并肾周渗出、结石的数量、大小、输尿管管壁厚度均具有统计学意义(P<0.001),通过ROC曲线分析得出分界点3.15 mm对应的诊断指数最大。结论输尿管管壁厚度可以预测输尿管下段梗阻性结石,从而预测输尿管镜碎石术的难易度。

Objective To evaluate the significance of ureteral wall thickness(UWT)for predicting the presence of distal ureter impacted stones in patients with ureteral stones undergoing ureteroscopic lithotripsy(URSL).Methods We retrospectively analyzed 320 procedures in patients with distal ureter impacted stones who underwent URSL between February 2014 and February 2018.Maximum UWT at the stone site was measured from computed tomography images.Receiver operating characteristic curve analysis was applied to determine the UWT cutoff value and to evaluate its accuracy in predicting impacted stones.Results Of the 320 patients,119 involved patients with impacted stones.The univariate analysis showed significant differences in perirenal exudation,stone number and size and UWT.The receiver operating characteristic curve analysis showed that 3.15 mm was the optimal cutoff value for UWT,with a predictive accuracy of 0.94.Conclusions UWT is associated with surgical outcomes in patients with distal ureter impacted stones ondergoing URSL.