CAJ | 학술논문

目的：分析影响软性输尿镜碎石术（ flexible ureteroscopic lithotripsy，FURL）清石率的相关因素，初步建立清石指数（ stone free index，SFI）模型来评估和预测FURL的疗效。方法回顾性收集我院2013年5月至2014年8月393例行FURL的患者资料，以体质指数、肾积水程度、有无菌尿、肾功能不全、结石部位、数目、结石累计最大径（ cumulative stone diameter，CSD）、结石密度、平均CT值、结石所在盏长轴与肾盂输尿管长轴最小夹角、结石所在盏平均盏颈长度、结石所在盏颈宽度与肾盏横径最小比值等所有的患者及结石特征为研究对象，同时统计一期术后结石清除率。对结石的术前特征和结石清除率关系进行多元回归分析并建立数学模型。结果本组术后一期结石清除率为92．4％（363／393）。多因素分析发现是否鹿角形结石、菌尿、CSD、结石平均CT值、结石所在盏颈平均长度、结石所在盏颈宽度与肾盏横径的最小比值这6项因素对于影响术后SFR有统计学意义（ P＜0．05）。 Logistic回归分析得到由4个自变量即是否鹿角形结石、CSD、结石所在盏平均盏颈长度、盏颈宽度与肾盏横径最小比值建立的Logistic回归模型，并据此建立SFI分值系统。对于预测一期术后清石效果，SFI的受试者工作特征曲线下面积达0．867。 SFI值＞7．5分预示FURL具有较高的清石率（ SFR＞85％）。结论在FURL手术中存在对清石效果有临床意义的影响因素，应用这些影响因素，我们初步建立了预测FURL术后疗效的清石指数模型来评估一期手术的清石率，该模型尚需前瞻性研究来进一步验证。
목적：분석영향연성수뇨경쇄석술（ flexible ureteroscopic lithotripsy，FURL）청석솔적상관인소，초보건립청석지수（ stone free index，SFI）모형래평고화예측FURL적료효。방법회고성수집아원2013년5월지2014년8월393례행FURL적환자자료，이체질지수、신적수정도、유무균뇨、신공능불전、결석부위、수목、결석루계최대경（ cumulative stone diameter，CSD）、결석밀도、평균CT치、결석소재잔장축여신우수뇨관장축최소협각、결석소재잔평균잔경장도、결석소재잔경관도여신잔횡경최소비치등소유적환자급결석특정위연구대상，동시통계일기술후결석청제솔。대결석적술전특정화결석청제솔관계진행다원회귀분석병건립수학모형。결과본조술후일기결석청제솔위92．4％（363／393）。다인소분석발현시부록각형결석、균뇨、CSD、결석평균CT치、결석소재잔경평균장도、결석소재잔경관도여신잔횡경적최소비치저6항인소대우영향술후SFR유통계학의의（ P＜0．05）。 Logistic회귀분석득도유4개자변량즉시부록각형결석、CSD、결석소재잔평균잔경장도、잔경관도여신잔횡경최소비치건립적Logistic회귀모형，병거차건립SFI분치계통。대우예측일기술후청석효과，SFI적수시자공작특정곡선하면적체0．867。 SFI치＞7．5분예시FURL구유교고적청석솔（ SFR＞85％）。결론재FURL수술중존재대청석효과유림상의의적영향인소，응용저사영향인소，아문초보건립료예측FURL술후료효적청석지수모형래평고일기수술적청석솔，해모형상수전첨성연구래진일보험증。
Objective To analyze the related factors that influence the stone free rate ( SFR) in flexible ureteroscopic lithotripsy ( FURL ) and develop a stone free index ( SFI ) model to estimate and predict the outcome of FURL.Methods A total of 393 patients receiving FURL were included in this study from May 2013 to August 2014.All patients′and calculous characteristics were recorded.It was evaluated the correlation of one-stage SFR with body mass index, the degree of hydronephrosis, the sterile urine, the renal insufficiency, the stone location, the stone number, the cumulative stone diameter ( CSD) , the stone density, the average of CT values, the minimum angle of pelvis ureter long axis with lamp long axis, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.Multivariate regression analysis was used to analyze the relationship between preoperative characteristics and the SFR.Results The one-stage postoperative SFR in our study was 92.4% ( 363/393).We found that the staghorn stone, bacteriuria, CSD, average of CT values, the average length of stone located calyx-neck, the minimum ratio of stone located calyx-neck′width with calyx′width were significantly correlated with the postoperative SFR ( P <0.05 ) .We used logistic regression analysis to determine statistical significant variables and to create predictable mathematical model.The SFI system was consist of four stone characteristics, including the staghorn stone, the cumulative stone diameter, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.The SFI had a high ROC curve (AUC=0.867) for predicting the one-stage postoperative stone free outcome.SFI score >7.5 meant a relatively high SFR ( SFR>85%) of FURL.Conclusions A SFI model using preclinical data was developed to predict the postoperative outcome of FURL, as well as the one-stage SFR.This model needs further prospective studies in the future.