输尿管软镜术后输尿管狭窄危险因素分析  

作　　者：沈悦凡[1] 钟欢[1] 沈俊文[1] 邵四海[1] 王荣江[1] 

机构地区：[1]浙江省湖州市第一人民医院,313000

出　　处：《浙江临床医学》2022年第11期1681-1682,1685,共3页Zhejiang Clinical Medical Journal

摘　　要：目的分析输尿管软镜术后输尿管狭窄的危险因素,并探讨输尿管狭窄的治疗方法。方法去回顾性分析2015年1月至2018年6月因输尿管上段结石行输尿管软镜手术患者688例。狭窄患者为病例组,非狭窄患者为对照组,比较两组临床特征和术中术后各指标的差异,应用Logistic回归分析狭窄的危险因素。统计狭窄治疗方式及成功率。结果纳入447例患者(469侧),输尿管狭窄占总病例数的4.22%。狭窄组与非狭窄组比较,肾绞痛、肾积水程度、输尿管支架是否通过结石、手术时间和输尿管穿孔差异有统计学意义。Logistic回归结果显示,术前肾积水程度和输尿管穿孔是输尿管狭窄的危险因素(P<0.05)。21例狭窄患者再次手术治疗,其中2例行患肾切除术,11例狭窄切除吻合术后再通,1例球囊扩张术后再通,4例行内镜下激光切开术失败,3例仅更换输尿管支架,其中1例拔管后再通。结论术前中重度肾积水和术中输尿管穿孔是软镜术后输尿管狭窄的危险因素。腹腔镜或开放重建手术治疗狭窄成功率高。Objective To investigate the risk factors of ureteral stricture after flexible ureteroscopy and to discuss the surgical treatment of ureteral stricture.Methods 688 patients who underwent flexible ureteroscopy for upper ureteral stones in our hospital from January 2015 to January 2018 were retrospectively analyzed.Patients with stricture was taken as a case group and patients without stricture was taken as a control group.Clinical characteristics and intraoperative and postoperative variables of the two groups were compared.Logistic regression analysis was used to find risk factors for stricture.The stricture treatment methods and successful cases were reported,and the success rate of various surgical treatment methods was compared.ResultsA total of 447 patients with 469 sides operations were selected.Ureteral stricture accounted for 4.22%of the total cases.There were statistically differences between the stricture group and the non-stricture group in renal colic,hydronephrosis,whether the ureteral stent passed the stone,operation time and ureteral perforation.Logistic regression showed that the degree of preoperative hydronephrosis and ureteral perforation were statistically significant(P<0.05).Twenty-one patients with stricture were reoperated.Of these,Il received reconstructive surgery were successful,I received balloon dilatation was successful,and 4 received failed endoscopic laser resection.Nephrectomy was performed in 2 patients,long-term replacement of ureteral stent was performed in 3 patients,and recanalization was performed in I patient after extubation.Conclusion Moderate to severe pre-operative hydronephrosis and intraoperative ureteral perforation are risk factors for ureteral stricture after flexible ureteroscopy.Laparoscopic or open reconstructive surgery has a high successrate in the treatment of stricture,while endourological treatment has.a lowsuccess rate.

关 键 词：输尿管软镜 输尿管狭窄 危险因素 手术治疗 

分 类 号：R699.4[医药卫生—泌尿科学]