输尿管软镜手术清石效率及相关影响因素分析

Analysis of the Efficiency of Flexible Ureteroscopic Surgery and Related Influencing Factors

摘要: 目的：研究单次输尿管软镜碎石取石术治疗肾结石的清石效率及相关影响因素。方法：回顾性分析2021年1月至2022年8月在深圳市人民医院接受单次输尿管软镜碎石取石术，术后影像学检查无残留结石的100例患者的临床资料。使用MIMICS (Materialise’s interactive medical image control system)软件对术前结石CT影像进行3D重建并计算结石体积负荷，结合手术时间得出单位时间内结石清除体积作为清石效率(mm³/min)，并对结石体积、年龄、性别、体质指数(Body Mass Index BMI)、结石左右侧、结石部位、结石数量、结石平均CT值、结石成分等可能的影响因素进行分析。100例患者中，男性61例，女性39例；年龄(49.36 ± 12.92)岁；结石位于左侧55例，右侧45例；BMI (24.37 ± 3.04) kg/m²；结石平均CT值(858.49 ± 244.07) HU；全下盏结石29例，非全下盏结石71例；结石主要成分为草酸钙结石72例，非草酸钙结石19例，数据缺失9例；单个结石77例，结石数量 ≥ 2个23例；结石体积中位值529.03 (256.79, 1115.87) mm³ (表1)。结果：100例患者手术均顺利完成，清石效率中位值9.46 (4.70, 19.01) mm³/min。单因素分析结果，结石体积负荷与清石效率呈正相关(P < 0.05)；全下盏结石与非全下盏结石的清石效率中位值分别为5.18 (4.09, 11.96) mm³/min和12.90 (5.38, 21.23) mm³/min，差异有统计学意义(P < 0.05)；结石数量为单个和≥2个的清石效率中位值分别为8.35 (4.09, 16.71) mm³/min与13.85 (8.53, 23.00) mm³/min，差异有统计学意义(P < 0.05，表2)。多因素分析结果，体积是清石效率的独立影响因素(P < 0.05，表3)。结论：MIMICS软件结合CT影像对结石进行3D成像并精确测量体积，有助于计算单位时间的清石体积，为评估可能的手术时长提供依据；结石体积、数量、部位是清石效率的影响因素。

Abstract: Objective: To investigate the stone removal efficiency and related influencing factors of single flexible ureteroscope lithotripsy in the treatment of kidney stones. Methods: The clinical data of 100 patients who underwent a single flexible ureteroscopic lithotripsy at Shenzhen People’s Hospital from January 2021 to August 2022 and were found to have no residual stones by imaging after surgery were retrospectively analyzed. MIMICS (Materialise’s interactive medical image control system) software was used to reconstruct the preoperative stone CT images and calculate the stone volume load, and the stone removal volume per unit time was obtained as the stone removal efficiency (mm³/min) in combination with the operation time. The possible influencing factors such as stone volume, age, gender, BMI, stone location (left and right), whether it is a total lower calyx calculus, the number of stones, the average CT value of stones, and the components of stones were analyzed. Among the 100 patients, 61 were males and 39 were females, age (49.36 ± 12.92) years; There were 55 cases on the left side and 45 cases on the right side of the stone. BMI (24.37 ± 3.04) kg/m²; The mean CT value of stones was (858.49 ± 244.07) HU. There were 29 cases of total lower calyx calculus and 71 cases of non-whole lower calyx calculus. There were 72 cases of calcium oxalate stones and 19 cases of non-calcium oxalate stones, and 9 cases were missing data. There were 77 cases of single stones, and the number of stones ≥ 2 were 23 cases. The median stone volume was 529.03 (256.79, 1115.87) mm³ (Table 1). Results: All 100 patients successfully completed the operation, and the median stone removal efficiency was 9.46 (4.70, 19.01) mm³/min. The results of univariate analysis showed that there was a positive correlation between stone volume load and stone removal efficiency (P < 0.05), and the median stone removal efficiency of total and non-whole lower calyx calculus was 5.18 (4.09, 11.96) mm³/min and 12.90 (5.38, 21.23) mm³/min, respectively, with a statistically significant difference (P < 0.05). The median efficiency of stone removal for the number of single stones and ≥2 stones was 8.35 (4.09, 16.71) mm³/min and 13.85 (8.53, 23.00) mm³/min, respectively, with statistical significance (P < 0.05, Table 2). The results of multivariate analysis suggested that volume was an independent factor of stone clearing efficiency. Conclusion: MIMICS software combined with CT images can perform 3D imaging of stones and accurately measure the volume, which is helpful to calculate the volume of stone clearing per unit time, and provides a basis for evaluating the stone removal time. The volume, number and location of stones are the influencing factors of stone removal efficiency.