基于Logistic模型分析输尿管上段结石微创手术后发生结石逃逸的危险因素

Risk factors of retrograde ureteral stone migration after minimally invasive surgery for upper ureteral calculi based on Logistic model

目的基于Logistic模型分析输尿管上段结石微创手术后发生结石逃逸的危险因素。方法回顾性选取2020年8月至2022年8月琼海市人民医院收治的123例输尿管上段结石患者,均行输尿管钬激光碎石术,根据结石逃逸情况分为未逃逸组(n=88)与逃逸组(n=35),行结石逃逸的单因素分析,多因素Logistic模型研究患者结石逃逸的影响因素,Spearman检验进行相关性分析,受试者工作特征(ROC)曲线评价模型诊断效能。结果2组年龄、体重指数、性别、饮酒史占比、吸烟史占比、脑血管疾病病史占比、冠心病病史占比、糖尿病病史占比、高血压病史占比、结石大小、结石数目差异均无统计学意义(P>0.05)。与未逃逸组比较,逃逸组术前肾积水轻中度占比、术中未使用输尿管管路封堵器占比、术中泵注0.9%氯化钠溶液压力值≥200 mmHg占比明显增高,差异均有统计学意义(P<0.05)。多因素Logistic模型显示,术前肾积水处于轻中度、输尿管管路封堵器术中未使用情况、术中泵注0.9%氯化钠溶液压力值≥200 mmHg为患者结石逃逸发生的危险因素(P<0.05)。Spearman检验数据提示,患者结石逃逸与术中泵注0.9%氯化钠溶液压力值呈正相关(P<0.05),与输尿管管路封堵器术中使用情况、术前肾积水程度呈负相关(P<0.05)。绘制ROC曲线显示,unite(三变量综合)的AUC值为0.960,分别大于术中泵注0.9%氯化钠溶液压力值(0.855)、输尿管管路封堵器术中使用情况(0.763)、术前肾积水程度(0.769),提示三项指标联合应用于评估患者结石逃逸的效能明显优于单一指标(P<0.05)。结论术前肾积水处于轻中度、输尿管管路封堵器术中未使用情况、术中泵注0.9%氯化钠溶液压力值≥200 mmHg为患者结石逃逸发生的危险因素,如发现上述情况应高度警惕患者发生结石逃逸的风险,并尽早干预。

Objective To screen the risk factors of retrograde ureteral stone migration after minimally invasive surgery for upper ureteral calculi based on Logistic model.Methods One hundred and twenty-three patients with upper ureteral calculi in Qionghai People's Hospital from August 2020 to August 2022 were retrospectively enrolled.All patients received ureterorenoscopic lithotripsy.Patients were classified into two groups according to the presence or absence of retrograde migration of ureteral stones,non-migration group(n=88)and migration group(n=35).Univariate analysis and multivariate Logistic model were used to screen the factors affecting retrograde migration in patients.Correlation analysis was performed by Spearman's rank correlation analysis.Receiver operating characteristic curve(ROC)was plotted to evaluate the diagnostic efficacy of the model.Results No statistical difference was found between two groups in terms of age,body mass index,gender,drinking history,smoking history,cerebrovascular disease history,coronary heart disease history,diabetes history,hypertension history,stone size,and number of stones(P>0.05).The proportion of patients with preoperative mild to moderate hydronephrosis,intraoperative use of ureteral occluder,and intraoperative pumping injection of 0.9%normal saline≥200 mmHg in migration group was notably larger than that of non-migration group,the difference was statistically significant(P<0.05).Multivariate Logistic model denoted that preoperative mild to moderate hydronephrosis,non-use of ureteral occluder during operation,and intraoperative pumping injection of 0.9%normal saline≥200 mmHg were risk factors for retrograde ureteral stone migration(all P<0.05).Spearman test data showed that the incidence rate of retrograde ureteral stone migration was positively correlated with the intraoperative pressure of 0.9%normal saline(P<0.05),and negatively correlated with the intraoperative use of ureteral occluder and the severity degree of preoperative hydronephrosis(P<0.05).In the evaluation of retrograde ureteral stone migration,ROC curve showed that the AUC of unite application of three variables was 0.960,which was greater than that of separate application of intraoperative pressure of 0.9%normal saline(0.855),intraoperative use of ureteral occluder(0.763)and preoperative degree of hydronephrosis(0.769),suggesting that the combined application of the three indexes had a significantly better efficacy than the separate index in evaluating retrograde migration in patients(P<0.05).Conclusion Preoperative mild to moderate hydronephrosis,intraoperative non-use of ureteral occluder,and intraoperative pump pressure of 0.9%normal saline≥200 mmHg are identified as risk factors for the occurrence of retrograde migration in patients,so early interventions are of great value in patients at high risk of retrograde ureteral stone migration.