CAJ | 학술논문

目的探讨肾下盏解剖结构对输尿管软镜下钬激光碎石治疗肾下盏结石疗效的影响.方法选取2007年1月至2011年12月肾下盏结石患者60例,男38例,女22例.年龄23～78岁,平均51岁.平均身高169.8 cm,平均体质量71.2 kg.均行IVU检查,测量肾盂输尿管与肾下盏漏斗部夹角、肾下盏漏斗部长度及最窄处宽度,分析其与输尿管软镜下钬激光碎石术疗效间的关系.结果本组60例中,42例治愈,年龄(50.1 ±14.6)岁,体质量(71.4±5.5)kg,身高(169.8±5.1)cm,结石最大径(10.9 ±2.1)mm,结石面积(85.4 ±9.5) mm2,盏颈长度(36.3 ±3.7)mm,盏颈宽度(4.9±1.4)mm；18例未治愈,年龄(51.7±11.7)岁,体质量(70.6±4.7)kg,身高(169.9±6.4)cm,结石最大径(11.3 ±2.4)mm,结石面积(82.5 ±8.6)mm2,盏颈长度(37.2±2.3)mm,盏颈宽度(4.8 ±1.9)mm,两组比较差异均无统计学意义(P＞0.05).肾盂输尿管与肾下盏漏斗部夹角治愈组为(63.4 ±23.2)°,未治愈组为(45.3±17.6)°,两组比较差异有统计学意义(P＜0.05).夹角≥45°者清石率为84.6％,＜45°者清石率为42.7％,两组比较差异有统计学意义(P＜0.05).按肾盂输尿管与肾下盏漏斗部夹角进行分组,夹角＞90°组治愈率为92.3％(12/13),夹角30° ～90°组为73.2％(30/41),夹角＜30°组为0％ (0/6).Logistic回归分析结果表明肾盂输尿管与肾下盏漏斗部夹角是输尿管软镜下钬激光碎石术疗效的独立影响因素(OR=1.12,P＜0.05).结论肾盂输尿管与肾下盏漏斗部夹角大小直接影响输尿管软镜下钬激光碎石术治疗肾下盏结石的疗效,夹角越小,碎石效果越不理想.
목적 탐토신하잔해부결구대수뇨관연경하화격광쇄석치료신하잔결석료효적영향.방법 선취2007년1월지2011년12월신하잔결석환자60례,남38례,녀22례.년령23～78세,평균51세.평균신고169.8 cm,평균체질량71.2 kg.균행IVU검사,측량신우수뇨관여신하잔루두부협각、신하잔루두부장도급최착처관도,분석기여수뇨관연경하화격광쇄석술료효간적관계.결과 본조60례중,42례치유,년령(50.1 ±14.6)세,체질량(71.4±5.5)kg,신고(169.8±5.1)cm,결석최대경(10.9 ±2.1)mm,결석면적(85.4 ±9.5) mm2,잔경장도(36.3 ±3.7)mm,잔경관도(4.9±1.4)mm；18례미치유,년령(51.7±11.7)세,체질량(70.6±4.7)kg,신고(169.9±6.4)cm,결석최대경(11.3 ±2.4)mm,결석면적(82.5 ±8.6)mm2,잔경장도(37.2±2.3)mm,잔경관도(4.8 ±1.9)mm,량조비교차이균무통계학의의(P＞0.05).신우수뇨관여신하잔루두부협각치유조위(63.4 ±23.2)°,미치유조위(45.3±17.6)°,량조비교차이유통계학의의(P＜0.05).협각≥45°자청석솔위84.6％,＜45°자청석솔위42.7％,량조비교차이유통계학의의(P＜0.05).안신우수뇨관여신하잔루두부협각진행분조,협각＞90°조치유솔위92.3％(12/13),협각30° ～90°조위73.2％(30/41),협각＜30°조위0％ (0/6).Logistic회귀분석결과표명신우수뇨관여신하잔루두부협각시수뇨관연경하화격광쇄석술료효적독립영향인소(OR=1.12,P＜0.05).결론 신우수뇨관여신하잔루두부협각대소직접영향수뇨관연경하화격광쇄석술치료신하잔결석적료효,협각월소,쇄석효과월불이상.
Objective To evaluate the impact of lower renal calyceal anatomic structure on flexible fibreoptic ureteroscopy with holmium laserin treatment of calyceal calculi.Methods From January 2007 to December 2011,a total of 60 patients with a lower calyceal renal stone were enrolled in this study.The mean age was 51 years (range 23 to 78 years).The mean height was 169.8 cm,and mean body mass was 71.2 kg.Intravenous urogram (IVU) was performed on all patients and the lower pole anatomy (including infundibulopelvic angle,length of the inferior caliceal infundibulum and infundibular width) were measured in these patients.The correlation between lower pole anatomy and the success of flexible fibreoptic ureteroscopy with holmium laser for calyceal calculi was analyzed.Results Of the 60 patients,42 patients were successful in stone clearance.The patients in the stone-free group age of (50.1 ± 14.6) years,height (169.8 ±5.1) cm,body mass (71.4 ±5.1) kg,the maximum stone size in diameter (10.9 ±2.1) mm,stone burden (85.4 ± 9.5) mm2,lower infundibular length (36.3 ± 3.7) mm and lower infundibular width (4.9 ±1.4) mm; the other 18 patients age (50.7 ± 11.7) years,height (169.9 ±6.4) cm,body mass (71.6±4.7) kg,the maximum stone size in diameter (11.3 ±2.4) mm,stone burden (82.5 ±8.6)mm2,lower infundibular length (37.2 ± 2.3) mm and lower infundibular width (4.8 ± 1.9) mm.There was no difference between the stone-free group and the residual group in all above parameters (P ＞ 0.05).However,the infundibulopelvic angle in the stone-free group was significantly greater than that in the residual group (63.4 ± 23.2 vs 45.32 ± 17.6,P ＜ 0.05).x2 test showed the stone clearance rate in patients with angle ≥45 was better than that in those with angle ＜45 (84.6％ vs 42.7％,P ＜0.05).If grouped by infundibulopelvic angle,patients with infundibulopelvic angle greater than 90°had stone clearance rate 92.3％ (12/13),those with angle ranged from 30° to 90° had 73.2％ (30/41),and those with infundibulopelvic angle smaller than 30° had 0％ (0/6).Logistic regression analysis showed that the angle was a significant independent predictor of stone clearance (OR =1.12,P ＜ 0.05).Conclusions The infundibulopelvic angle has adverse influences on the performances of flexible ureteroscopy.The samller the angle is,the poorer the performances of flexible ureteroscopy is.