- 學位論文
體外震波碎石手術處理泌尿系統結石成功率之預測方程式
Predictive Equation of Successful Treatment in Patients with Urolithiasis Undergoing Extracorporeal Shock Wave Lithotripsy
摘要
體外震波碎石術(Extracorporeal Shock Wave Lithotripsy , ESWL)為現今有效治療尿路結石症的方法，無需住院，不需要麻醉以及手術時間短之非侵入式手術方式，對於現今患者是一大福音。然而目前臨床上少有能夠預測患者接受體外震波碎石術之後結石是否能夠清除的預測方程式，因此本研究開發出一套體外震波碎石手術成功率預測方程式。藉由回溯性研究方法，收集102年1月至12月共641位，於恩主公醫院接受體外震波術的患者進行統計、分析進而得出手術成功率之預測方程式。以Akaike Information Criterion(AIC)爲準則指標來選取在何種自變數的組合下，能得到最佳模式(Top Model)找出5項因子：身體質量數(平均26.3±4.11, P=0.005)、結石長度(平均9.38±4.42mm, P<0.001)、結石寬度(平均6.25±2.81mm, P<0.001)、術前是否有雙丁輸尿導管(P=0.001)、結石的位置(P <0.001)，以上列五項因子得出一邏輯斯迴歸方程式可以計算出手術成功機率值，進行Propensity ROC後，以計算出的成功機率大於58%則定義爲手術成功。再進行十次的建模以及驗證過程，將結果取平均。所得出手術成功預測：準確率為75.68%。並將結果撰寫成網頁，使醫生藉由程式運算於診斷時即可判斷患者是否適合進行體外震波術。
並列摘要
Extracorporeal shock wave lithotripsy (ESWL) is effective for treating the urolithiasis with several advantages including no hospitalization, no anesthesia, short operative time, and non-invasive procedure. However, to our knowledge, there is no prediction method that can be used to predict the successful rate of ESWL. Thus, the aim of the study is to develop a prediction formula which can accurately predict the prognosis of patients undergoing ESWL. Using a retrospective evaluation, we collected 641 patients’ data and analyzed the prediction formula. To get the top model, we took Akaike Information Criterion (AIC) as a criterion to select different combinations of independent variables. There were five key factors in this top model: body mass index (BMI, average 26.3±4.11, P=0.005), stone length (average 9.38±4.42mm, P<0.001), stone width (average 6.25 ± 2.81mm, P <0.001), double-J ureteral stent ( P=0.001), stone location (P <0.001). Based on these factors, we built a logistic regression with propensity ROC which can calculate the probability of successful operation (the definition of successful operation: the probability is higher than 58 percent). After that, it was dealt with 10 times cross-validation and then being averaging. Prediction for successful operation: accuracy rate was 75.68%. This result was placed on website to provide urologists to decide whether patients were adequate candidates for receiving ESWL.