首次输尿管软镜碎石术中输尿管导入鞘放置困难患者的高危特征分析研究  

High Risk Characteristics Analysis of Patients with Placement Difficulty of Ureteral Access Sheath in the First Retrograde Intrarenal Surgery

作　　者：胡智玉 郝斌[1] 王鹏森[1] 

机构地区：[1]郑州大学第二附属医院泌尿外科,河南省郑州市450014

出　　处：《中国全科医学》2017年第5期599-602,共4页Chinese General Practice

摘　　要：目的分析首次输尿管软镜碎石术中输尿管导入鞘放置困难患者的高危临床及影像学特征。方法选取2014年9月—2016年5月郑州大学第二附属医院首次接受输尿管软镜碎石术治疗的上尿路结石患者142例(单侧119例,双侧23例),共165例次,根据患侧输尿管导入鞘放置成功与否,将其分为放置成功组和放置困难组。收集患者的临床特征和影像学特征,采用多因素Logistic回归分析患者输尿管导入鞘放置困难的影响因素。结果放置成功组118例患者,141例次;放置困难组24例患者,24例次。放置成功组和放置困难组患侧D-J管留置史、患侧输尿管镜手术史、术中扩张输尿管发生率、患侧肾萎缩、30 min静脉肾盂造影(IVP)输尿管显影程度比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,患侧D-J管留置史〔OR=0.111,95%CI(0.013,0.928)〕、患侧输尿管镜手术史〔OR=0.102,95%CI(0.012,0.867)〕是输尿管导入鞘放置成功的预测因素(P<0.05),30 min IVP输尿管完全不显影〔OR=4.562,95%CI(1.388,14.992)〕是输尿管导入鞘放置困难的预测因素(P<0.05)。结论 D-J管留置史及输尿管镜手术史减少输尿管导入鞘放置困难的风险,30 min IVP输尿管完全不显影增加输尿管导入鞘放置困难的风险。因此在输尿管软镜碎石术前关注患者的临床及影像学资料,可有效评估输尿管导入鞘放置困难的发生风险。Objective To analyze the high risk clinical and imaging characteristics of patients with the placement difficulty of ureteral access sheath （UAS） in the first retrograde intrarenal surgery （RIRS）. Methods A total of 142 patients with calculus of upper urinary tract （119 with unilateral ureteral obstruction, 23 with bilateral ureteral obstruction, 165 sldes） , who underwent RIRS in the Second Affiliated Hospital of Zhengzhou University from September 2014 to May 2016, were selected. According to whether success placing UAS or not during treatment, patients were divided into success placement group and difficulty placement group. The clinical characteristics and imaging characteristics of patients were collected. Multivariate Logistic regression was used to analyze the influencing factors of the difficuhy in placing UAS. Results The success placement group had 118 patients, and 141 sides totally. While the difficulty placement group had 24 patients and 24 sides. There was significant difference in indwelling history of D-J tube, ureteroscopic surgery history, incidence of ureteral dilation, nephrarctia, and ureteral development degree of intravenous pyelogram （IVP） for 30 minutes in the affected side between two groups （ P 〈 0. 05 ）. Multivariate Logistic regression analysis showed that indwelling history of D-J tube in the affected side [ OR = 0. 111, 95% CI （0. 013, 0. 928） ], the history of ureteroscopic surgery in the affected side [ OR =0. 102, 95% CI （0. 012, 0. 867） were the predictive factors of the placement success of UAS （ P 〈 0. 05 ） , no ureteral image in the 30 - minute IVP [ OR = 4. 562, 95% CI （ 1. 388, 14. 992） ~ was the predictive factor of the placement difficulty in UAS （ P 〈 0. 05 ）. Conclusion The indwelling D-J tube and history of ureteroscopic surgery can reduce the risk of the placement difficulty in UAS, and no ureteral iamge in the 30 - minute IVP increases the risk of the placement difficulty in UAS. Therefore, pay attention to the clinical a

关 键 词：输尿管结石 输尿管镜检查 输尿管导入鞘 

分 类 号：R693.4[医药卫生—泌尿科学]