目的 探讨体外冲击波碎石对肾结石的治疗效果及手术失败的影响因素。方法 选取2016年5月—2022年5月收治的600例肾结石患者进行回顾性分析,所有患者均采取体外冲击波碎石治疗,分析碎石成功率。按手术是否成功分为观察组（n=476）和对照组（n=124）。比较两组患者一般资料和手术情况,并分析体外冲击波碎石手术失败的影响因素。结果 600例患者中1次碎石成功率为79.33%。并发症发生率为2.33%,并发症通过抗感染治疗后均明显好转。两组患者性别、年龄、既往结石手术史、平均病程、血尿、疼痛、肾积水等项目比较差异无统计学意义（P>0.05）。两组患者体质量指数（BMI）、结石大小、结石位置、手术体位、冲击次数、术者工作年限比较差异有统计学意义（P<0.05）。两组患者手术区域、碎石电压比较差异无统计学意义（P>0.05）;Logistic回归分析结果表明：手术体位、结石大小以及冲击次数是体外冲击波碎石手术失败的独立危险因素（P<0.05）。结论 体外冲击波碎石对肾结石的治疗成功率为79.33%,且安全性较高。肾结石患者体外冲击波碎石手术失败的影响因素主要包括手术体位、结石大小以及冲击次数。因此,临床上对于结石较大的患者应尽量采取仰卧位,并在确保患者安全情况下增加冲击次数,进一步提升体外冲击波碎石治疗成功率。
Objective To explore the therapeutic effect of extracorporeal shock wave lithotripsy on renal calculi and the influencing factors of surgical failure. Methods A retrospective analysis was performed on 600 outpatients and inpatients with kidney stones admitted to our hospital from May 2016 to May 2022. All patients received extracorporeal shock wave lithotripsy and success rate was calculated. The observation group （n=476） and the control group （n=124） were divided according to whether the surgery was successful or not. The general data and the operation conditions of patients in the two groups were compared, and the independent factors affecting the failure of extracorporeal shock wave lithotripsy were analyzed. Results The success rate of primary lithotripsy was 79.33% in the 600 patients. The complication rate was 2.33%, and all patients improved significantly after anti-infection treatment. There was no significant difference between the two groups in terms of gender, age, history of stone surgery, average disease duration, hematuria, pain, hydronephrosis, and other clinical symptoms （P>0.05）; there was a significant difference between the two groups in terms of body mass index （BMI）, stone size, stone location, surgical position, number of impacts, and operator's working years （P<0.05）; there was no significant difference between the two groups in terms of surgical area and lithotripsy voltage （P>0.05）. The results of regression analysis showed that surgical position, stone size, and number of impacts were independent risk factors for failure of extracorporeal shock wave lithotripsy for kidney stone treatment （P<0.05）. Conclusion The success rate of extracorporeal shock wave lithotripsy for renal calculi is 79.33%, and it is safe. The factors associated with the failure of extracorporeal shock wave lithotripsy for renal calculi mainly include the surgical position, the size of the calculi, and the number of shocks. Therefore, clinically, patients with large stones should try to adopt supine position, and increase the number of shocks while ensuring the safety of patients, so as to further improve the success rate of extracorporeal shock wave lithotripsy.
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