输尿管单发结石患者体外冲击波碎石术的冲击波频率研究 及碎石效果的影响因素探讨. (Chinese)

Objective: To explore the optimal frequency of extracorporeal shock wave lithotripsy (ESWL) in patients with single ureteral calculi, and to analyze the influencing factors of lithotripsy effect. 148 patients with single ureteral calculi who received treatment in Air Force 986 Hospital from April 2020 to April 2022 were selected as the research objects. According to the treatment frequency, the patients were divided into low frequency group (48 cases, frequency 60~70 times /min) and medium frequency group (51 cases, frequency 80~90 times /min) and high frequency group (49 cases, 100~120 times /min), and the lithotripsy outcome, renal function index and the occurrence of complications in the three groups were observed. The lithotripsy outcome in the three groups of patients were counted, they were divided into successful group and failure group according to different lithotripsy outcome. General data of all patients were collected, and multivariate Logistic regression was used to analyze the influencing factors of lithotripsy effect in patients with single ureteral calculi. Results: There was no significant difference in the success rate of lithotripsy in the three groups (P>0.05). Urea nitrogen (BUN) and serum creatinine (Scr) in the three groups at 1 d after operation and 14 d after operation were increased, and then decreased (P<0.05). BUN and Scr in the high frequency group and medium frequency group at 1 d after operation were higher than those in the low frequency group, and the high frequency group was higher than the medium frequency group (P<0.05). The total incidence rate of complications in the high frequency group and medium frequency group were higher than that in the low frequency group (P<0.05). Univariate analysis showed that lithotripsy failure after ESWL in patients with single ureteral calculi were related to the course of disease, stone location, stone diameter, renal colic, stone incarceration and taking tamsulosin (P<0.05). Multivariate Logistic regression analysis showed that the longer the course of disease, the middle and lower part of stone location, the larger stone diameter, stone incarceration, and not taking tamsulosin were the risk factors for lithotripsy failure (P<0.05). Conclusion: ESWL at low, medium and high frequencies showed good lithotripsy effect in patients with single ureteral calculi. However, with the increase of frequency, the patients with transient renal injury increased, and the risk of complications also increased. In addition, the longer the course of disease, the middle and lower part of stone location, the larger stone diameter, stone incarceration, and not taking tamsulosin are risk factors for lithotripsy failure, which can be considered in combination with the above factors for comprehensive evaluation to select the best treatment. [ABSTRACT FROM AUTHOR]

目的：探讨输尿管单发结石患者体外冲击波碎石术（ESWL）的最佳冲击波频率，并分析碎石效果的影响因素。方法：选取 2020 年 4 月 ~2022 年 4 月期间来空军第九八六医院接受治疗的输尿管单发结石患者 148 例作为研究对象，按照不同治疗频率将 患者分为低频组（48 例，频率为 60~70 次 /min）、中频组（51 例，频率为 80~90 次 /min）和高频组（49 例，频率为 100~120 次 /min）， 观察三组患者的碎石结局、肾功能指标以及并发症发生情况。统计三组患者的碎石结局，按照碎石结局的不同分为成功组和失败 组。收集所有患者的一般资料，采用多因素 Logistic 回归分析输尿管单发结石患者碎石效果的影响因素。结果：三组碎石成功率组 间对比无统计学差异（P>0.05）。三组术后 1 d、术后 14 d 尿素氮（BUN）、血肌酐（Scr）均升高后下降（P<0.05）。高频组、中频组术后 1 d BUN、Scr 均高于低频组，且高频组高于中频组（P<0.05）。高频组、中频组的并发症总发生率高于低频组（P<0.05）。单因素分析 显示，输尿管单发结石患者 ESWL 术后碎石失败与病程、结石位置、结石直径、肾绞痛、结石嵌顿、服用坦索罗辛有关（P<0.05）。多 因素 Logistic 回归分析显示，病程偏长、结石位置中下段、结石直径偏大、结石嵌顿、未服用坦索罗辛是碎石失败的危险因素（P＜ 0.05）。结论：低、中、高三种频率下的 ESWL 用于输尿管单发结石患者，均有较好的碎石效果。但随着频率的增加，患者一过性肾功 能损伤增大，且并发症发生风险也相应增加。此外，病程偏长、结石位置中下段、结石直径偏大、结石嵌顿、未服用坦索罗辛是碎石 失败的危险因素，可考虑结合上述因素进行综合评估选择最佳治疗方式。 [ABSTRACT FROM AUTHOR]

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