【摘要】：目的分析首次輸尿管軟鏡碎石術(shù)中輸尿管導(dǎo)入鞘放置困難患者的高危臨床及影像學(xué)特征。方法選取2014年9月—2016年5月鄭州大學(xué)第二附屬醫(yī)院首次接受輸尿管軟鏡碎石術(shù)治療的上尿路結(jié)石患者142例(單側(cè)119例,雙側(cè)23例),共165例次,根據(jù)患側(cè)輸尿管導(dǎo)入鞘放置成功與否,將其分為放置成功組和放置困難組。收集患者的臨床特征和影像學(xué)特征,采用多因素Logistic回歸分析患者輸尿管導(dǎo)入鞘放置困難的影響因素。結(jié)果放置成功組118例患者,141例次;放置困難組24例患者,24例次。放置成功組和放置困難組患側(cè)D-J管留置史、患側(cè)輸尿管鏡手術(shù)史、術(shù)中擴(kuò)張輸尿管發(fā)生率、患側(cè)腎萎縮、30 min靜脈腎盂造影(IVP)輸尿管顯影程度比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素Logistic回歸分析結(jié)果顯示,患側(cè)D-J管留置史〔OR=0.111,95%CI(0.013,0.928)〕、患側(cè)輸尿管鏡手術(shù)史〔OR=0.102,95%CI(0.012,0.867)〕是輸尿管導(dǎo)入鞘放置成功的預(yù)測因素(P0.05),30 min IVP輸尿管完全不顯影〔OR=4.562,95%CI(1.388,14.992)〕是輸尿管導(dǎo)入鞘放置困難的預(yù)測因素(P0.05)。結(jié)論 D-J管留置史及輸尿管鏡手術(shù)史減少輸尿管導(dǎo)入鞘放置困難的風(fēng)險(xiǎn),30 min IVP輸尿管完全不顯影增加輸尿管導(dǎo)入鞘放置困難的風(fēng)險(xiǎn)。因此在輸尿管軟鏡碎石術(shù)前關(guān)注患者的臨床及影像學(xué)資料,可有效評估輸尿管導(dǎo)入鞘放置困難的發(fā)生風(fēng)險(xiǎn)。
[Abstract]:Objective to analyze the high risk clinical and imaging features of difficult placement of ureteral sheath during the first lithotripsy. Methods from September 2014 to May 2016, 142 patients with upper urinary calculi (119 unilateral and 23 bilateral) who were treated with ureteral soft lithotripsy in the second affiliated Hospital of Zhengzhou University were selected for 165 times. According to the successful placement of ureteral sheath, the ureteral sheath was divided into two groups: successful placement group and difficult placement group. The clinical and imaging features of the patients were collected. Multivariate Logistic regression analysis was used to analyze the influencing factors of difficult placement of ureteral sheath. Results in the successful placement group, there were 141 cases of successful placement and 24 cases of difficult placement group. There were significant differences in the history of D-J tube indwelling, the history of ureteroscopy, the incidence of ureteral dilatation, and the degree of (IVP) ureteral development in 30 min of renal atrophy in the successful group and the difficult group (P0.05). Multivariate Logistic regression analysis showed that the indwelling history of D-J tube in the affected side was 0.111 ~ 95), (CI 0.013 ~ 0.928),). The history of ureteroscopy (ORO 0.102 ~ 95CI (0.012 ~ 0.867) was a predictor of successful ureteral sheath placement (P0.05). (P0.05) 30 min IVP ureteral failure (ORV 4.562 ~ 95CI (1.388n 14.992) was a predictor of difficult placement of ureteral sheath (P0.05). Conclusion the history of D-J tube indwelling and ureteroscopy can reduce the risk of difficult placement of ureteral sheath and increase the risk of difficult placement of ureteral sheath for 30 min IVP. Therefore, the risk of difficult placement of ureteral sheath can be effectively evaluated by paying attention to the clinical and imaging data of patients before ureteroscopic lithotripsy.
【作者單位】： 鄭州大學(xué)第二附屬醫(yī)院泌尿外科;
【分類號】：R699
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本文編號：2188840