摘要
目的:探讨复杂性肾结石患者术前CT评估输尿管中段直径对一期成功置鞘的影响。方法:选择2020年4月至2023年5月于北京市隆福医院泌尿外科就诊的200例复杂性肾结石患者。根据一期碎石术置鞘情况分为成功组(n=115)与失败组(n=85)。比较两组患者的临床资料和输尿管中段直径。利用最小绝对收缩选择算子(LASSO)回归法和多因素Logistic回归分析影响一期置鞘结果的危险因素。广义混合效应模型分析输尿管中段直径与一期成功置鞘的关系。限制性立方样条图分析输尿管中段直径与一期成功置鞘之间的剂量-反应关系。建立回归方程y=1-1/(1+e-z)预测模型并进行验证。结果:成功组输尿管中段直径显著大于失败组(P<0.05)。LASSO回归和多因素Logistics回归分析显示调整潜在混杂因素后,发现身体质量指数(BMI)、结石数量、结石大小、结石类型、输尿管中段直径均是复杂肾结石患者一期置鞘失败的影响因素(P<0.05)。输尿管中段直径与一期置鞘失败风险呈显著负相关(P<0.001),且与性别无关。经Bootstrap自抽样,预测模型区分度、准确度较好。结论:复杂性肾结石患者术前CT评估输尿管中段直径对一期成功置鞘具有重要意义,输尿管中段直径是影响一期置鞘结果的危险因素。
Objective:To investigate the impact of preoperative computed tomography(CT)assessment of midureteral diameter on the success of single-stage ureteral access sheath(UAS)placement in patients with complex re⁃nal calculi.Methods:A total of 200 patients with complex renal calculi treated at the Urology Department of Beijing Longfu Hospital between April 2020 and May 2023 were enrolled.Patients were categorized into a Success group(n=115)or a Failure group(n=85)based on the outcome of single-stage UAS placement during primary lithotripsy.Clinical data and mid-ureteral diameter were compared between groups.The Least Absolute Shrinkage and Selection Operator(LASSO)regression and multivariable logistic regression analyses were employed to identify risk factors in⁃fluencing single-stage UAS placement success.The association between mid-ureteral diameter and successful sheath placement was analyzed using a generalized linear mixed-effects model.The dose-response relationship between midureteral diameter and placement success was visualized using restricted cubic splines.A predictive model based on the regression equation y=1-1/(1+e-z)was developed and validated.Results:The mid-ureteral diameter was signifi⁃cantly larger in the Success group compared to the Failure group(P<0.05).LASSO regression and multivariable lo⁃gistic regression analyses,after adjusting for potential confounders,identified body mass index(BMI),stone number,stone size,stone type,and mid-ureteral diameter as significant independent factors influencing single-stage UAS placement failure(P<0.05).Mid-ureteral diameter demonstrated a significant inverse correlation with the risk of UAS placement failure(P<0.001),independent of sex.Bootstrap internal validation indicated good discrimination and calibration of the predictive model.Conclusion:Preoperative CT assessment of mid-ureteral diameter is a signifi⁃cant predictor for successful single-stage UAS placement in patients with complex renal calculi.Mid-ureteral diameter is an independent risk factor influencing the outcome of single-stage sheath placement.
作者
高翔
张洪波
张大坤
郑瀚
高纪元
孟强
张浪
郭婷秀
Gao Xiang;Zhang Hongbo;Zhang Dakun;Zheng Han;Gao Jiyuan;Meng Qiang;Zhang Lang;Guo Tingxiu(Department of Urology,Beijing Longfu Hospital,Beijing 100010,China)
出处
《微创泌尿外科杂志》
2025年第3期167-175,共9页
Journal of Minimally Invasive Urology
关键词
复杂性肾结石
输尿管中段直径
一期成功置鞘
complex renal calculi
mid-ureteral diameter
primary successful ureteral stent placement
