| [Objective]To evaluate the feasibility of ureteral wall thickness(UWT)as a predictor of impacted upper ureteral stone,and to explore the combination of UWT with other factors and patients undergoing Percutaneous Nephrolithotomy(PCNL)during the operation Systemic inflammatory response syndrome(SIRS)occurs after surgery.[Methods]A retrospective analysis of the relevant data of 68 patients with PCNL due to upper ureteral stones in the First Affiliated Hospital of Kunming Medical University,and the correlation between them and stone incarceration was obtained.Whether the upper ureteral stones were impacted was diagnosed according to the observations during the operation.The data analyzed include the basic condition of the patient,stone information,the condition seen during PCNL operation,and the monitoring and follow-up of relevant indicators before and after the operation.Among them,the focus is on the UWT analysis measured on the patient’s CT plain scan.Use t-test and chi-square test to analyze which indicators are related to the occurrence of impacted upper ureteral stone,and construct binary logistic regression based on meaningful single factors to obtain independent predictive factors,and draw ROC curve analysis can be used as independent predictive factors UWT and get the best prediction value.Then,68 patients were divided into groups with the best predictive value and divided into a high UWT group greater than the best predictive value and a low UWT group less than the best predictive value,to analyze the influence of UWT on PCNL intraoperative findings and postoperative complications.The postoperative SIRS and non-SIRS patients were further divided into groups,and the basic condition of the patients,stone information and the impact of the monitoring of preoperative and postoperative related indicators on postoperative SIRS were analyzed.The t-test and the chi-square test were used to analyze which indicators are related to PCNL surgery.The subsequent occurrence of SIRS is correlated,and a binary logistic regression is constructed based on meaningful single factors to obtain independent predictors.[Results]Among 68 patients with ureteral calculi,34 cases of non-impacted upper ureteral stone belonged to the control group,and 34 cases of impacted upper ureteral stone belonged to the experimental group.The statistical methods of chi-square test and t-test showed that the two groups were in the control group.There were statistically significant differences in the lateral diameter of the patient’s calculus,the maximum UWT,the diameter of the 3mm ureter above the stone,the maximum average UWT before and after the left and right,the maximum average UWT for each layer,and the degree of preoperative hydronephrosis(P<0.05).A binary logistic regression was constructed with single-factor meaningful variables as dependent variables,and the analysis showed that the maximum value of the UWT average value of each layer and the degree of preoperative hydronephrosis can be used as independent risk factors for predicting impacted upper ureteral stone.The ROC curve was drawn to analyze each The predictive value of the maximum value of the average value of UWT in the upper segment of the upper segment of the ureteral stone impacted,the area under the curve is 0.802,the best predictive value is 4.12mm,the corresponding sensitivity=0.765,specificity=0.824.In the impacted group,there are 26 patients with a maximum average UWT per layer ≥4.12 mm,and 8 patients with a maximum average UWT per layer<4.12 mm.In the non-impacted group,6 patients have an average UWT per layer The maximum value is≥4.12mm,and the average maximum value of UWT in each layer of 28 patients is less than 4.12mm.The ROC curve was drawn to analyze the predictive value of the degree of preoperative hydronephrosis for upper ureteral stones impacted.The predicted result showed that the area under the ROC curve was 0.853,that is,the degree of preoperative hydronephrosis was used as an indicator to diagnose upper ureteral stone.The accuracy is 85.3%,P=0.000,sensitivity=0.912,specificity=0.794.According to the best predicted value of the maximum UWT average value in each layer,68 stone patients were divided into a high UWT group of 32 cases(the maximum UWT average value of each layer≥4.12 mm)and a low UWT group of 36 cases(the maximum UWT average value of each layer)Value<4.12mm),of which 26 patients in the high UWT group were impacted stones,6 patients were non-impacted stones,in the low UWT group,8 patients were impacted stones,and 28 patients were non-impacted stones.The t-test and the chi-square test were used to compare whether the stones seen during the operation and whether SIRS occurred in the two groups were related to the UWT measurement value.The results showed that the stones in the high UWT group were fixed on the ureteral wall during the operation(P=0.001)and The possibility of stones being wrapped by polyps(P=0.005)was higher than that of the low UWT group.In the low UWT group,there were 27 cases of SIRS after operation,9 cases of non-SIRS,23 cases of SIRS after operation,and 9 cases of non-occurring SIRS in the high UWT group.After using the chi-square test analysis,P=0.771.In the high UWT group,6 cases had ureteral stenosis,26 cases had no ureteral stenosis,0 cases had ureteral stenosis in the low UWT group,and 36 cases had no ureteral stenosis.Chi-square test was used.The analysis showed that P=0.000,the difference was statistically significant.Therefore,a higher average maximum value of UWT per layer indicates that the situation seen under endoscopy is worse,and the ureteral stenosis is more likely to occur after surgery,but it does not indicate that SIRS is more likely to occur after surgery.We divided 68 patients into SIRS group and non-SIRS group,and calculated the correlation of various factors,including UWT and hydronephrosis degree.We found that there were statistical differences in stone vertical diameter,operation time,urine white blood cell,and stone residue.Significance(P<0.05),a binary logistic regression was constructed with single-factor meaningful variables as dependent variables,and the analysis showed that the vertical diameter of the stone,the operation time and the residual stone can be used as independent risk factors for SIRS after surgery.[Conclusions]The maximum average value of UWT in each layer and the degree of preoperative hydronephrosis can be used as independent risk factors for predicting impacted upper ureteral stone.The vertical diameter of the stone,the operation time and the residual stone are independent risk factors for the occurrence of SIRS after PCNL.For patients with risk factors for impacted upper ureteral stone,they should be informed before surgery that the difficulty of the operation may be greater,reducing doctor-patient disputes,and performing fine operations during the operation to prevent complications such as ureteral perforation,bleeding,and postoperative ureteral stenosis.At the same time,in order to avoid the occurrence of SIRS in patients with upper ureteral stones after PCNL,we should pay attention to the diameter of the stones on the coronal plane before the operation,and budget the lithotripsy time to improve the proficiency of the PCNL operation,without affecting the effect of the operation.Shorten the operation time,reduce the amount of fluid perfusion,and reduce the rate of residual stones.Patients with residual stones after surgery should be closely monitored,so as to effectively prevent the occurrence of SIRS in patients with upper ureteral stones after PCNL. |
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