Piezolith 3000 plus碎石机体外冲击波治疗单发输尿管结石的安全性和有效性及其失败因素分析

Extracorporeal shock wave lithotripsy with Piezolith 3000 plus in the management of single ureteral stone:An analysis of its safety,efficacy and failure factors

目的:探讨新一代双层压电碎石机Piezolith 3000 plus体外冲击波碎石术(SWL)治疗单发输尿管结石的安全性和疗效及其失败因素。方法:选取2019年2月至2022年7月温州医科大学附属台州医院应用Piezolith 3000 plus体外碎石机治疗的3515例单发输尿管结石患者,男2167例,女1348例;年龄10个月至76岁[(41.2±9.3)岁]。其中儿童(<14岁)9例(0.25%),男4例,女5例。结石位于输尿管上段1620例(46.1%),中段489例(13.9%),下段1406例(40.0%)。结石大小0.7~2.0(0.94±0.16)cm。记录和评估患者治疗后的清石率、辅治率、复治率以及相关并发症等。结果:3515例患者中一次性成功碎石2897例(82.42%),3个月清石率为91.04%,再治疗率为8.62%,总体效率商为81.7。血尿是术后最常见的并发症,未发现严重并发症。多因素Logistic回归分析发现,BMI>25 kg/m~2(OR=1.795,95%CI=1.127~3.157)、结石大小≥1.0 cm(OR=2.157,95%CI=1.413~5.647)、结石位置输尿管下段(上段,OR=3.155,95%CI=1.399~11.765;中段,OR=6.098,95%CI=1.569~52.632)和重度肾积水(轻度,OR=1.244,95%CI=1.054~1.686;中度,OR=1.335,95%CI=1.088~1.569)是SWL失败的重要独立预测因素(P<0.05)。结论:双层压电式Piezolith 3000 plus碎石机具有碎石颗粒细小,清石率高,相对无痛、无创的优点,治疗单发输尿管结石安全、有效;BMI>25 kg/m~2、结石长径≥1.0 cm、结石位于输尿管下段和重度肾积水是SWL失败的独立预测因素。

Objective:To investigate the safety,efficacy and failure factors of the latest generation Piezolith 3000 plus extracorporeal shock wave lithotripsy(SWL)in the treatment of single ureteral stone.Methods:A total of 3515 patients underwent Piezolith 3000 plus SWL for single ureteral stone from February 2019 to July 2022.There were 2167 males and 1348 females with a mean age of(41.2±9.3)years(range,10 months to 76 years),in which there were 9 children(0.25%)including 4 males and 5 females.The single stone was located in the upper ureter in 1620(46.1%),the mid-ureter in 489(13.9%),and the lower ureter in 1406(40.0%).The diameter of stone was 0.7-2.0(0.94±0.16)cm.The stone-free rate,auxiliary treatment rate,re-treatment rate and related complications were recorded and evaluated.Results:Of 3515 patients,2897(82.42%)were successfully treated with SWL at once,with the stone-free rate at 3mo being 91.04%,the re-treatment rate 8.62%,and the overall efficiency quotient(EQ)81.7.Hematuria was the most common postoperative complication and no serious complications were found.In univariate analysis,calculous location,size,and grade of hydronephrosis between two groups showed significant differences(all P<0.05).The predictive factors of SWL failure were BMI>25 kg/m~2(OR=1.795,95%CI=1.127-3.157),calculous size≥1.0 cm(OR=2.157,95%CI=1.413-5.647),calculous location(upper ureter,OR=3.155,95%CI=1.399-11.765;mid-ureter,OR=6.098,95%CI=1.569-52.632)and severe grade of hydronephrosis(mild,OR=1.244,95%CI=1.054-1.686;Moderate,OR=1.335,95%CI=1.088-1.569).Conclusion:The double-layer Piezolith 3000 plus lithotripter is safe and effective in the treatment of single ureteral stone with the advantages of fine gravel particles,high overall stone-free rate and being relatively painless and non-invasive.BMI>25 kg/m~2,calculous size≥1 cm,location and severe hydronephrosis are importment independnt predictors of SWL failure.