CAJ | 학술논문

目的分析与体外冲击波碎石术(ESWL)最终治疗效果相关的因素。方法选择2010年7月～2012年5月经因输尿管结石进行ESWL的患者。收集了患者临床和影像数据，对与ESWL治疗失败可能的相关因素进行分析。结果共有52例患者（25.6%）ESWL手术失败，平均随访期为41 d。有40例患者（19.7%）需要再次治疗，其中12例进行了再次ESWL术，28例进行了输尿管镜检查。与ESWL 治疗成功的患者相比，ESWL失败的患者具有较高的体重、身体质量指数（BMI）和臀围（BC）。单变量分析表明结石负担（比值比[OR]：1.04；95%置信区间[CI]：1.03～1.06）和BC（OR：1.06；95%CI：1.01～1.11）是ESWL失败的相关因子，BMI是具有临界意义的潜在相关变量（OR：1.09；95% CI：0.99～1.20）。多变量分析表明对于所有患者来说结石负担（OR：1.04；95% CI：1.03-1.06）是显著预测因子。在根据输尿管结石位置的水平对患者进行分层时，发现BC（OR：1.35；95%CI：1.02～1.80）是中段/下段输尿管结石ESWL失败的独立预测因子，而BMI（OR：1.47；95% CI：1.13～1.91）是上段输尿管结石ESWL失败的独立预测因子。结论结石负担是所有输尿管结石患者ESWL术失败的主要预测因子。而BC和BMI分别是中段/下段输尿管结石和上段输尿管结石ESWL失败的独立预测因子。
목적분석여체외충격파쇄석술(ESWL)최종치료효과상관적인소。방법선택2010년7월～2012년5월경인수뇨관결석진행ESWL적환자。수집료환자림상화영상수거，대여ESWL치료실패가능적상관인소진행분석。결과공유52례환자（25.6%）ESWL수술실패，평균수방기위41 d。유40례환자（19.7%）수요재차치료，기중12례진행료재차ESWL술，28례진행료수뇨관경검사。여ESWL 치료성공적환자상비，ESWL실패적환자구유교고적체중、신체질량지수（BMI）화둔위（BC）。단변량분석표명결석부담（비치비[OR]：1.04；95%치신구간[CI]：1.03～1.06）화BC（OR：1.06；95%CI：1.01～1.11）시ESWL실패적상관인자，BMI시구유림계의의적잠재상관변량（OR：1.09；95% CI：0.99～1.20）。다변량분석표명대우소유환자래설결석부담（OR：1.04；95% CI：1.03-1.06）시현저예측인자。재근거수뇨관결석위치적수평대환자진행분층시，발현BC（OR：1.35；95%CI：1.02～1.80）시중단/하단수뇨관결석ESWL실패적독립예측인자，이BMI（OR：1.47；95% CI：1.13～1.91）시상단수뇨관결석ESWL실패적독립예측인자。결론결석부담시소유수뇨관결석환자ESWL술실패적주요예측인자。이BC화BMI분별시중단/하단수뇨관결석화상단수뇨관결석ESWL실패적독립예측인자。
Objective To explore predictors of disintegration failure in ESWL for a solitary ureteral calculus. Methods From July 2010 to May 2012, 203 patients who underwent ESWL for a solitary ureteral calculus were enrolled.Clinical and radiologic data were collected,and factors related to ESWL failure were analyzed. Results Fifty two patients (25.6%) showed ESWL failure,with a mean follow up of 41 days.Forty patients (19.7%)required retreatment,including 12 who underwent repeat ESWL and 28 who underwent curative ureteroscopy.Patients with ESWL failure had significantly higher body weight,body mass index (BMI),and buttock circumference (BC) than patients for whom ESWL was successful.Univariate analysis showed that stone burden(odds ratio[OR]:1.04;95%confidence interval[CI]:1.03-1.06)and BC(OR:1.06;95%CI:1.01-1.11)were predictors of ESWL failure,while BMI was a potential predictor with borderline significance(OR:1.09;95% CI,0.99-1 .20).Multivariate analysis showed that stone burden(OR:1.04; 5% CI:1.03-1.06) was a significant predictor for all patients.On stratifying patients according to the level of ureteral calculi, BC was found to be an independent predictor(OR:1.35; 95% CI:1.02-1.80) for ESWL failure for middle/lower ureteral calculi and BMI(OR:1.47;95% CI:1.13-1.91)for upper ureteral calculi. Conclusion Stone burden is the main predictor of ESWL failure for all patients with ureteral calculi.BC and BMI are independent predictors for ESWL failure for middle/lower and upper ureteral calculi,respectively.