微创PCNL治疗维吾尔族和汉族儿童上尿路结石的疗效、安全性及复发预测

IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY
Ruiyu Yue, Shao Zhang, Kahriman Islam, Jesur Batur, Youquan Zhao, Xiaochuan Wang, Jun Li
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引用次数: 0

摘要

目的:评价维吾尔族和汉族儿童上尿路结石行微创经皮肾镜取石术(PCNL)的疗效、安全性和复发风险,并建立基于图线的术后复发预测模型。方法:回顾性分析2019年6月至2024年6月期间接受Mini-PCNL或Microperc治疗的231例儿童(维吾尔族159例,汉族72例)的临床资料。使用Kaplan-Meier估计分析无复发生存率。采用Cox回归构建两个模型:模型1(门诊临床预测模型,OCPM)基于临床变量,模型2(综合住院预测模型,CIPM)纳入影像学和尿培养。建立模态图,并使用随时间变化的ROC曲线、校准曲线和10倍交叉验证来评估模型的性能。采用决策曲线分析(DCA)和临床影响曲线(CIC)评价临床效用。结果:两组无结石及并发症发生率比较,但维吾尔族患儿复发率较高(25.2% vs 13.9%, HR = 2.31, 95% CI: 1.30 ~ 4.10)。模型1 (OCPM、年龄、种族、尿pH、血清肌酐)在门诊筛查中具有良好的辨别能力(AUC为0.79-0.85),而模型2 (CIPM,添加结石大小、侧侧性、多样性和肾积水)在较高风险水平下具有更高的准确性(AUC为0.90)和校准。结论:PCNL在两族患者中均有效且安全,但维吾尔族患者复发风险较高。预测模型为优化术后管理和随访策略提供了有价值的工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy, Safety, and Recurrence Prediction of Minimally Invasive PCNL in Uygur and Han Pediatric Patients with Upper Urinary Tract Calculi.

Objectives: To evaluate the efficacy, safety, and recurrence risk of minimally invasive percutaneous nephrolithotomy (PCNL) in Uyghur and Han pediatric patients with upper urinary tract calculi and develops predictive models with nomograms for postoperative recurrence.

Methods: Clinical data from 231 children (159 Uyghur, 72 Han) treated with Mini-PCNL or Microperc between June 2019 and June 2024 were retrospectively reviewed. Recurrence-free survival was analyzed using Kaplan-Meier estimates. Cox regression was applied to construct two models: Model 1 (Outpatient Clinical Predictive Model, OCPM) based on clinical variables, and Model 2 (Comprehensive Inpatient Predictive Model, CIPM) incorporating imaging and urine culture. Nomograms were established, and model performance was assessed using time-dependent ROC curves, calibration curves, and 10-fold cross-validation. Clinical utility was evaluated by decision curve analysis (DCA) and clinical impact curves (CIC).

Results: Stone-free and complication rates were comparable between groups, but Uyghur children had a higher recurrence rate (25.2% vs. 13.9%, HR = 2.31, 95% CI: 1.30-4.10). Model 1 (OCPM, age, ethnicity, urine pH, serum creatinine) showed good discrimination for outpatient screening (AUC 0.79-0.85), while Model 2 (CIPM, adding stone size, laterality, multiplicity, and hydronephrosis) achieved superior accuracy (AUC > 0.90) and calibration at higher-risk levels.

Conclusion: PCNL is effective and safe in both ethnic groups, but Uyghur patients have a higher recurrence risk. The predictive models provide valuable tools for optimizing postoperative management and follow-up strategies.

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来源期刊
Urologia Internationalis
Urologia Internationalis 医学-泌尿学与肾脏学
CiteScore
3.30
自引率
6.20%
发文量
94
审稿时长
3-8 weeks
期刊介绍: Concise but fully substantiated international reports of clinically oriented research into science and current management of urogenital disorders form the nucleus of original as well as basic research papers. These are supplemented by up-to-date reviews by international experts on the state-of-the-art of key topics of clinical urological practice. Essential topics receiving regular coverage include the introduction of new techniques and instrumentation as well as the evaluation of new functional tests and diagnostic methods. Special attention is given to advances in surgical techniques and clinical oncology. The regular publication of selected case reports represents the great variation in urological disease and illustrates treatment solutions in singular cases.
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