摘要
目的:分析输尿管软镜钬激光碎石术治疗输尿管上段复杂性结石后双J管附壁结石形成的原因.方法:选择2015年1月至2023年8月于首都医科大学附属北京潞河医院收治的105例输尿管上段复杂性结石患者,其中男58例,女47例,根据结石评估结果分为结石组(n=40)与非结石组(n=65).通过随机森林算法分析患者双J管附壁结石形成的影响因素.通过单因素和多因素分析双J管附壁结石形成的独立影响因素,并构建分类树模型.结果:结石组和非结石组CT值、术中出血量、双J管留置时间、白细胞计数(WBC)、C反应蛋白(CRP)、尿酸(UA)、血钙、尿pH值、尿蛋白、尿红细胞、尿白细胞、尿结晶比较差异均有统计学意义(t/χ2 值分别为4.361、2.502、6.815、12.176、24.398、15.595、6.517、2.069、6.881、4.524、3.883、4.699,均P<0.05).双J管留置时间、尿蛋白阳性、尿结晶阳性、UA为双J管附壁结石形成的独立危险因素(P<0.05).分类树模型显示,双J管留置时间是双J管附壁结石形成的重要预测因素,收益图和索引图显示模型预测良好.结论:双J管留置时间、尿蛋白阳性、尿结晶阳性、UA为双J管附壁结石形成的独立危险因素.临床应重点关注相关因素,及时制定预防策略,以期降低双J管附壁结石的发生风险.
Abstract
Objective:To analyze the causes of encrustation formation on double-J stents after flexible ureteros-copy with holmium lase lithotripsy for the treatment of upper ureteral complex stones.Methods:105 patients with complex upper ureteral stones admitted to Beijing Luhe Hospital Affiliated to Capital Medical University from Janu-ary 2015 to August 2023 were selected,including 58 males and 47 females.According to the evaluation results of the stones,they were divided into stone group(n=40)and no stone group(n=65).Analyze the influencing factors of the formation of double J tube wall attached stones in patients using the random forest algorithm.Analyze the indepen-dent influencing factors of the formation of double J tube wall attached stones through single factor and multiple factor analysis,and construct a classification tree model.Results:There were statistically significant differences between the stone group and the non stone group in CT values,intraoperative blood loss,double J tube retention time,white blood cell count(WBC),C-reactive protein(CRP),uric acid(UA),blood calcium,urine pH,urine protein,urine red blood cells,urine white blood cells,and urine crystallization(t/χ2=4.361,2.502,6.815,12.176,24.398,15.595,6.517,2.069,6.881,4.524,3.883,4.699,respectively,all P<0.05).The duration of double J tube retention,posi-tive urine protein,positive urine crystallization,and UA were independent risk factors for the formation of double J tube wall attached stones(P<0.05).The classification tree model showed that the retention time of double J tubes was an important predictive factor for the formation of double J tube wall attached stones,and the profit and index charts showed that the model predicts well.Conclusion:The duration of double J tube retention,positive urine pro-tein,positive urine crystallization,and UA are independent risk factors for the formation of double J tube wall at-tached stones.Clinical attention should be paid to relevant factors and timely prevention strategies should be formulat-ed to reduce the risk of double J tube wall attached stones.
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