经尿道输尿管镜治疗输尿管结石后发生输尿管狭窄的危险因素分析  

Risk factors of ureteral stricture after ureteroscopy in the treatment of ureteral calculi

作　　者：吴佳成 姜力[1,2] 陆雅君[2] Wu Jiacheng;Jiang Li;Lu Yajun(Department of Urology, the No.202 Hospital of the PLA , Shenyang 110000, China;China Medical University, Shenyang 110000, China)

机构地区：[1]中国人民解放军第二0二医院泌尿外科,沈阳110000 [2]中国医科大学,沈阳110000

出　　处：《国际泌尿系统杂志》2019年第3期505-509,共5页International Journal of Urology and Nephrology

摘　　要：目的探究与分析经尿道输尿管镜治疗输尿管结石后发生输尿管狭窄的危险因素。方法回顾性分析本院2011年1月至2016年12月收治的1800例经尿道输尿管镜治疗的输尿管结石患者的临床资料,按照术后随访的结果分为输尿管狭窄组和非狭窄组,对两组患者的临床资料先采用χ2检验行单因素分析,然后采取非条件logistic回归行多因素分析,进而探讨造成输尿管狭窄的危险因素。结果1800例患者术后随访10~24个月,术后发生输尿管狭窄的患者共有92例(5.11%)。单因素分析结果显示,两组患者在病程、结石直径、多发结石、息肉包绕、嵌顿结石、治疗方式、肾积水程度、手术时长及术后有无脓毒血症等方面比较差异有统计学意义(P<0.05)。多因素分析结果显示输尿管狭窄的危险因素依次为:嵌顿结石(OR=3.79,P<0.001)、多发结石(OR=3.56,P<0.001)、大结石(OR=2.98,P<0.001)、钬激光手术(OR=2.51,P=0.029)、长病程(OR=1.98,P=0.048)、肾积水程度(OR=1.53,P<0.001)、息肉包绕(OR=1.21,P=0.013)。结论对于嵌顿结石、多发结石、结石较大、选择钬激光手术治疗、肾积水程度较大及结石有息肉包绕的输尿管结石患者,手术术后发生输尿管狭窄的风险增高,必须引起临床工作者的重视。Objective To explore and analyze the risk factors of ureteral stricture after transurethral ureteroscopic treatment of ureteral calculi. Methods The clinical data of 1800 patients with ureteral calculi treated by transurethral ureteroscopy in our hospital from January 2011 to December 2016 were retrospectively analyzed. According to the results of follow-up, the patients were divided into ureteral stricture group and non-stricture group, clinical data of two groups were analyzed using univariate analysis of chi-square test and a non-conditional logistic regression multivariate analysis, and then the risk factors for ureteral stricture were explored. Results A total of 1800 patients were followed up for 10-24 months. There were 92 patients (5.11%) with postoperative ureteral stenosis. There was difference was statistically significant in the course of disease, calculus diameter, multiple stones, polyps, incarcerated stones, treatment, degree of hydronephrosis, duration of surgery and postoperative sepsis between the two groups (P<0.05). Multivariate analysis showed that the risk factors of ureteral stricture were: incarcerated stones (OR=3.79, P<0.001), multiple stones (OR=3.56, P<0.001)(OR=1.98, P=0.048), hydronephrosis (OR=1.51, P<0.001). Conclu-sions For patients with impacted calculi, multiple stones, large stones, patients who are treated with holmium laser lithotripsy, hydronephrosis and polyp stones around the ureteral calculi, the risk of ureteral stricture increases after surgery and we must attach great importance to it.

关 键 词：输尿管结石 输尿管镜检查 缩窄 病理性 

分 类 号：R699[医药卫生—泌尿科学]