输尿管阴道瘘的疗效及其影响因素分析  

Efficacy and its influential factors for ureterovaginal fistula

作　　者：吴智威 郑秀惠 韩健 郭建新 WU Zhiwei;ZHENG Xiuhui;HAN Jian;GUO Jianxin(Department of Obstetrics and Gynecology,Army Medical Center of PLA,Chongqing 400042,China)

机构地区：[1]陆军特色医学中心妇产科,重庆400042

出　　处：《重庆医学》2023年第16期2401-2408,2415,共9页Chongqing medicine

基　　金：国家自然科学基金面上项目(81272864);重庆市卫生适宜技术推广项目(2018jstg026)。

摘　　要：目的探讨影响输尿管阴道瘘(UVF)治疗方式选择及疗效的临床因素。方法回顾性收集2013年1月至2021年12月于陆军军医大学3家附属医院治疗的122例UVF患者临床资料。根据初始治疗的有效性分为有效组(81例)与无效组(41例),另根据治疗方式分为经尿道输尿管支架置入术组(支架组,60例)和外科手术组(62例)。比较有效组与无效组,以及采取不同治疗方式的有效与无效患者的临床特征,并采用logistic回归分析分别探讨影响各组患者疗效的临床因素。结果治疗方式(OR=66.250,95%CI:7.763~1080.385,P<0.001)及治疗手术耗时(OR=0.985,95%CI:0.971~0.999,P=0.040)是UVF疗效的独立影响因素;支架组治疗有效率明显低于外科手术组(43.33%vs.88.71%,P<0.001)。输尿管损伤分级、术前血清白蛋白水平均是治疗方式选择的独立影响因素(P<0.05);医疗中心不同是支架组患者疗效的独立影响因素(P<0.05);术前血清尿素氮和血红蛋白水平是外科手术组患者疗效的独立影响因素(P<0.05)。结论治疗方式是影响UVF疗效的重要因素,外科手术治疗有效率明显高于支架置入,而治疗方式的选择及疗效受输尿管损伤分级、术前血清白蛋白、尿素氮和血红蛋白等临床因素的影响。Objective To investigate the clinical factors affecting the choice and effectiveness of treatment for ureterovaginal fistula(UVF).Methods The clinical data of 122 patients with UVF treated at three affiliated hospitals of the Army Medical University from January 2013 to December 2021 were retrospectively reviewed.According to the effectiveness of the initial treatment,patients were divided into two groups:the effective group(81 cases)and ineffective group(41 cases).According to the treatment modality,the patients were also divided into two groups:the ureteral stent insertion group(stent group,60 cases)and surgical group(62 cases).The clinical characteristics were compared between the effective and ineffective groups,as well as between the effective and ineffective patients treated with different methods.Logistic regression analysis was used to investigate the clinical factors influencing the therapeutic efficacy of patients in each group.Results Treatment modality(OR=66.250,95%CI:7.763-1080.385,P<0.001)and time-consuming of treatment procedures(OR=0.985,95%CI:0.971-0.999,P=0.040)were independent factors affecting the therapeutic efficacy of UVF.The effective rate of the stent group was significantly lower than that of the surgical group(43.33%vs.88.71%,P<0.001).The grading of ureteral injury and preoperative serum albumin level were identified as independent factors that influenced the choice of treatment modality(P<0.05).The variation among medical centers was found to be an independent factor that influenced the therapeutic efficacy of patients in the stent group(P<0.05).Preoperative serum urea nitrogen and hemoglobin levels were identified as independent factors that influenced the therapeutic efficacy of patients in the surgical group(P<0.05).Conclusion The treatment modality is an important factor that affects the effectiveness of UVF.The effective rate of surgical treatment is significantly higher than that of stent placement.The choice of treatment modality and its efficacy are influenced by clinical facto

关 键 词：输尿管阴道瘘 经尿道输尿管支架置入术 输尿管膀胱再植术 影响因素 疗效分析 回归分析 

分 类 号：R713.4[医药卫生—妇产科学]