2024 年第 8 期 第 0 卷

单侧输尿管上段结石输尿管硬镜钬激光碎石失败危险因素研究

Risk factors of failure in patients with unilateral upper ureteral calculi treated by rigid ureteroscopy holmium laser lithotripsy

作者：乔建坤1斯琴2刘治威1李鑫华1马可为1

英文作者：Qiao Jiankun1 Si Qin2 Liu Zhiwei1 Li Xinhua1 Ma Kewei1

单位：1内蒙古自治区人民医院泌尿外科，呼和浩特010017；2内蒙古自治区人民医院医学工程处，呼和浩特010017

英文单位：1Department of Urology Inner Mongolia People′s Hospital Hohhot 010017 China; 2Department of Medical Engineering Inner Mongolia People′s Hospital Hohhot 010017 China

关键词：输尿管结石；输尿管硬镜；钬激光

英文关键词：Ureteralcalculi;Rigidureteroscopy;Holmiumlaser

• 摘要：

• 目的 探讨单侧输尿管上段结石输尿管硬镜钬激光碎石失败危险因素。方法 选取2012年1月至2021年9月于内蒙古自治区人民医院行输尿管硬镜钬激光碎石术治疗单侧输尿管上段结石患者852例，其中术后1周评估碎石失败72例（碎石失败组），其余患者均碎石成功（碎石成功组）。分析患者临床资料，采用多因素Logistic回归模型分析影响因素。结果 碎石失败组左侧结石比例、多发结石比例、入镜困难比例、结石停留时间≥6周比例均高于碎石成功组，结石CT值和结石停留时间≥2周比例均低于碎石成功组，差异均有统计学意义（均P<0.05）。多因素Logistic回归分析结果显示入镜困难是本组患者中输尿管硬镜钬激光碎石失败的独立危险因素（比值比=2.64,95%置信区间：1.75~3.64，P=0.02）。结论 输尿管硬镜钬激光碎石术治疗单侧输尿管上段结石成功率较高，入镜困难是导致碎石失败的独立危险因素。

• Objective To explore the risk factors for failure in unilateral upper ureteral calculi treated with ureteroscopic holmium laser lithotripsy. Methods  Totally 852 patients with upper ureteral calculi treated by rigid ureteroscopy holmium laser lithotripsy were retrospectively chosen in Inner Mongolia People′s Hospital from January 2012 to September 2021 were enrolled, including 72 cases with lithotripsy failure evaluated a week after operation(lithotripsy failure group), and other patients with lithotripsy success(lithotripsy successful group). The clinical characteristics were analyzed and the independent risk factors of lithotripsy failure were evaluated by multivariate Logistic regression methods. Results  The proportions of stones located on the left side, multiple stones, difficulty in entering the endoscope and stone dwell time≥6 weeks in the lithotripsy failure group were higher than those in the lithotripsy successful group; the CT value of stones and stone dwell time≥2 weeks in the lithotripsy failure group were lower than those in the lithotripsy successful group (all P<0.05). The multivariate Logistic regression analysis showed that difficulty in ureteroscopy was an independent risk factor for the failure of ureteroscopic holmium laser lithotripsy (odds radio=2.64, 95% confidence interval：1.75-3.64, P=0.02). Conclusion  The success rate of ureteroscopic holmium laser lithotripsy for the treatment of unilateral upper ureteral stones is high, and difficulty in entering the ureteroscope is an independent risk factor for lithotripsy failure.