输尿管镜钬激光碎石术后输尿管狭窄的危险因素研究  

Study on the Risk Factors of Ureteral Stricture after Ureteroscopic Holmium Laser Lithotripsy

作　　者：夏天成 高茂 徐国政 张帅 XIA Tiancheng;GAO Mao;XU Guozheng;ZHANG Shuai(Department of Urology,Wuxi No.8 People's Hospital,Wuxi 214142,China;不详)

机构地区：[1]无锡市第八人民医院泌尿外科,江苏无锡214142

出　　处：《中国医学创新》2025年第6期116-120,共5页Medical Innovation of China

摘　　要：目的:分析输尿管镜钬激光碎石术后输尿管狭窄的独立危险因素。方法:选择2021年1月—2023年6月在无锡第八人民医院接受输尿管镜钬激光碎石术治疗的320例输尿管结石患者,根据术后随访1年是否发生输尿管狭窄,将患者分为狭窄组(n=26)和未狭窄组(n=294)。采用单因素和多因素分析评价输尿管结石患者术后输尿管狭窄的独立危险因素。结果:单因素分析结果显示,狭窄组结石最大径≥2 cm、结石嵌顿、中重度肾积水和钬激光损伤黏膜的患者占比均高于未狭窄组,且手术时间长于未狭窄组,差异均有统计学意义(P<0.05)。logistic回归分析表明,结石直径≥2 cm、结石嵌顿、中重度肾积水、手术时间和发生钬激光损伤黏膜是输尿管镜钬激光碎石术后输尿管狭窄的独立危险因素(P<0.05);通过ROC曲线下面积来验证logistic回归模型。ROC曲线结果显示,预测模型的敏感度为84.6%,特异度为85.7%,AUC为0.888。结论:结石直径、结石嵌顿、中重度肾积水、手术时间及钬激光损伤黏膜是输尿管镜钬激光碎石术后输尿管狭窄的独立危险因素。logistic回归模型具有较高的预测敏感度和特异度,可有效预测术后输尿管狭窄的发生,为临床决策提供了有力支持。Objective:To analyze the independent risk factors of ureteral stricture after ureteroscopic holmium laser lithotripsy.Method:A total of 320 patients with ureteral calculi who received ureteroscopic holmium laser lithotripsy treatment in Wuxi No.8 People's Hospital from January 2021 to June 2023 were selected.According to whether ureteral stenosis occurred during 1 year postoperative follow-up,the patients were divided into a narrow group(n=26)and a non-narrow group(n=294).Independent risk factors for postoperative ureteral stricture in patients with ureteral calculi were evaluated by univariate and multivariate analysis.Result:The results of univariate analysis showed that the proportions of patients with maximum stone diameter≥2 cm,stone incarceration,moderate and severe hydronephrosis and holmium laser injury of mucosa in the narrow group were higher than those in the non-narrow group,and the operation time was longer than that in the non-narrow group,the differences were statistically significant(P<0.05).logistic regression analysis showed that stone diameter≥2 cm,stone entrapment,moderate and severe hydronephrosis,operation time and the occurrence of holmium laser damage were independent risk factors for ureteral stenosis after ureteroscopic holmium laser lithotripsy(P<0.05).The logistic regression model was verified by the area under ROC curve.ROC curve results showed that the sensitivity of the prediction model was 84.6%,the specificity was 85.7%,and the AUC was 0.888.Conclusion:Stone diameter,stone incarceration,moderate to severe hydronephrosis,operation time and holmium laser lesion of the mucosa are independent risk factors for ureteral stricture after ureteroscopic holmium laser lithotripsy.logistic regression model has high predictive sensitivity and specificity,which can effectively predict the occurrence of postoperative ureteral stenosis,and provide strong support for clinical decision-making.

关 键 词：输尿管结石 钬激光碎石术 输尿管狭窄 危险因素 

分 类 号：R699.4[医药卫生—泌尿科学]