| 赵国斌,凌海滨,刘鑫,等.输尿管软镜碎石术 202例手术时间的影响因素[J].安徽医药,2020,24(7):1317-1320. |
| 输尿管软镜碎石术 202例手术时间的影响因素 |
| Influencing factors of operation time of flexible ureteroscopy lithotripsy |
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| DOI：10.3969/j.issn.1009?6469.2020.07.012 |
| 中文关键词: 肾结石/外科学 输尿管镜检查 线性模型 手术时间 |
| 英文关键词: Kidney stones/surgery Ureteroscopy Linear models Operation time |
| 基金项目:河北省科技计划自筹经费项目(172777182)；河北省重点科技研究计划项目( 20180839) |
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| 中文摘要: |
| 目的评价输尿管软镜碎石术( FURS)手术时间的影响因素。方法搜集河北北方学院附属第一医院 2013年 12月至 2018年 12月行 FURS病人 202例，均采用科医人钬激光碎石，术后 3个月复查 CT，151例病人无残石。根据术后结果将 202例病人分为三组，无残石组、残石 ≤4 mm组、残石＞ 4 mm组。比较三组病人一般资料及围手术期的情况，可能影响手术时间的因素 11个。手术时间和可能影响因素之间的相关性采用 spearman相关系数和多元性线性回归模型进行分析。结果无残石组结石数量( 2.1±1.7)个，结石体积( 648.6±692.5)mm3，肾下极结石 102例，最大 CT值( 1 051.4±4 103.0)HU，平均 CT值( 926.4± 343.3)HU，手术时间( 79.3±32.5)min均显著高于残石≤4 mm组( 2.8±1.9)个、(1 198.8±1 102.0)mm3、18例、(1 248.4±340.0)HU，(1087.3±351.9)HU，(106.2±32.4)min；并显著高于残石＞ 4 mm组( 3.4±2.0)个、(3 625.9±4 154.5)mm3、10例、(1 358.6±303.9) HU，(1 109.5±314.5)HU，(112.5±24.2)min。残石 ≤4 mm组结石体积( 1 198.8±1 102.0)mm3显著高于残石＞ 4 mm组( 3 625.9± 4 154.5)mm3。spearman相关系数表明了手术时间与结石体积呈显着正相关( r＝0.405，P＜0.001)，手术时间和 CT值之间呈正相关( r＝0.321，P＜0.001)。多元性线性回归模型分析采用强制进入和逐步选择的方法得出预测 FURS手术时间的六个因素:术前置入 D?J管，结石体积， CT值，外科医生经验，性别和软镜鞘直径。建立的预测手术时间模型中的决定系数( R2)为 0.318，预测模型的平均 R2值为 0.318±0.049。结论根据病人特征和外科医生的经验制订了 FURS手术时间模型，术前能可靠地预测手术时间，计划是否分期 FURS以及避免手术并发症。 |
| 英文摘要: |
| Objective To predict the influencing factors of the operation time of flexible ureteroscopy(FURS) operation time. Methods The clinical data of 202 patients with ureteroscopy lithotripsy(FURS)from the First Affiliated Hospital of Hebei NorthUniversity from December 2013 to December 2018 were collected.All patients were treated with laser lithotripsy.The CT was re?viewed 3 months after operation，and 151 patients had no residual stones.According to the postoperative results，202 patients were divided into three groups，no residual stone group，residual stone ≤4 mm group and residual stone＞4 mm group.Comparing the general data and the perioperation conditions of the three groups，there were 11 factors may affect the operation time.The correla?tion between operative time and possible influencing factors was analyzed using the spearman correlation coefficient and the multi?ple linear regression model.Results In the non?residual stone group，the number of stones(2.1±1.7)stone volume(648.6±692.5) mm3102 cases of inferior pole stones，maximum CT value(1 051.4±4 103.0)HU，average CT value(9，26.4±343.3)HU，operationtime(，79.3±32.5) min，all these index were significantly higher than the residual stone ≤4 mm group(2.8±1.9)，(1 198.8± 1 102.0)mm3，18 cases，(1 248.4±340.0)HU，(1 087.3±351.9)HU，(106.2±32.4)min；and also significantly higher than the re? sidual stone＞4 mm group(3.4±2.0)，(3 625.9±4 154.5)mm3，10 cases，(1 358.6±303.9)HU，(1 109.5±314.5)HU，(112.5±24.2)min.Stone volume(1 198.8±1 102.0)mm3 in group was significantly higher than the group(3625.9±4154.5)mm3.The spear? man correlation coefficient showed a significant positive correlation between operation time and stone volume(r＝0.405，P＜0.001)，and a positive correlation between operative time and CT value(r＝0.321，P＜0.001).Multivariate linear regression model analysis used forced entry and stepwise selection methods to derive six factors predicting FURS operation time:preoperative D?J tube，stone volume，CT value，surgeon experience，gender and soft sheath diameter.The coefficient of determination(R2)in the mod? el was 0.318，and the average R2 value of the prediction model is 0.318±0.049，and the formula for predicting the operation time model is obtained.Conclusion The FURS operation time model was developed based on patient characteristics and surgeons’ex? perience.which can reliably predict the operation time before surgery，whether the FURS is planned or not，and surgical complica? tions can be avoided. |
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