输尿管上段嵌顿性结石术后发生输尿管狭窄的影响因素分析

Analysis of influencing factors of postoperative ureteral stricture in patients with upper ureteral incarcerated stones

目的:探讨输尿管上段嵌顿性结石术后发生输尿管狭窄的影响因素。方法:回顾性分析443例输尿管上段嵌顿性结石患者的临床资料,比较术后有否发生输尿管狭窄患者的性别、年龄、结石位置、结石大小、结石CT值、术前肾积水程度、结石以上输尿管宽度、结石所在部位输尿管壁厚度(UWTmax)及结石周围输尿管息肉生长情况。采用多因素logistic回归分析筛选术后发生输尿管狭窄的独立预测因子;采用ROC曲线比较各指标在预测输尿管上段嵌顿性结石术后发生输尿管狭窄方面的价值。结果:术后发生输尿管狭窄患例者57例,未发生386例。单因素分析结果为,输尿管狭窄与非狭窄患者的UWTmax、结石以上输尿管宽度、结石周围输尿管伴息肉及术前肾积水程度的差异有统计学意义(P<0.05),而性别、年龄、结石位置、结石大小、结石CT值差异无统计学意义(P>0.05)。多因素分析结果为,结石以上输尿管宽度(Wals=11.530,OR=1.159,95%CI:1.064~1.262,P<0.001)、UWTmax(Wals=39.276,OR=15.543,95%CI:6.590~36.657,P<0.001)及结石周围输尿管伴息肉生长(Wals=13.331,OR=0.117,95%CI:0.037~0.370,P<0.001)是输尿管上段嵌顿性结石患者术后发生输尿管狭窄的独立预测因素。ROC曲线对预测因素的比较结果显示,结石部位输尿管壁厚度的曲线下面积(AUC)最大(AUC=0.842,P<0.001),其次为结石周围输尿管伴息肉生长(AUC=0.685,P<0.001)及结石以上输尿管宽度(AUC=0.677,P<0.001)。结论:结石以上输尿管宽度、UWTmax和结石周围输尿管伴息肉生长是输尿管上段嵌顿性结石患者术后是否发生输尿管狭窄的独立预测因素,其中预测能力最佳的是结石部位输尿管壁厚度,最佳预测值2.595 mm,特异性88.6%,敏感性74.5%。

Objective:To investigate the influencing factors of postoperative ureteral stricture in patients with upper ureteral incarcerated stones.Methods:A retrospective study was performed on the clinical data of 461 patients with upper ureteral incarcerated calculi who underwent surgery in our hospital from January 1,2014 to January 1,2019.The gender,age,stone location,stone size,CT value of the stones,preoperative hydronephrosis,ureteral width above the stones,maximum ureteral wall thickness at the stone site(UWTmax)and the growth of ureteral polyps below the stone were compared between the two groups of patients with ureteral stricture and no ureteral stricture.Multivariate logistic regression analysis was used to screen the independent predictors of postoperative ureteral stenosis.The ROC curve was used to compare the value of each index in predicting ureteral stenosis after operation in patients with upper ureteral incarcerated calculi.Results:Among the 461 cases of upper ureteral incarcerated calculi,57 cases had ureteral stricture,386 cases had no ureteral stricture,and 18 cases were lost to follow-up.Single-factor analysis showed that there were statistically significant differences in UWTmax,ureteral width above the calculi,the growth of ureteral polyps below the stone and degree of hydronephrosis between the two groups(P<0.05),and there were no statistically significant differences in gender,age,calculi location,calculi size and calculi CT value between two groups(P>0.05).Multivariate logistic regression analysis showed that the ureteral width above calculi(Wald value=11.530,OR=1.159,95%CI 1.064-1.262,P<0.001),UWTmax(Wald value=39.276,OR=15.543,95%CI 6.590-36.657,P<0.001)and the growth of ureteral polyps below the stone(Wald value=13.331,OR=0.117,95%CI 0.037-0.370,P<0.001)were independent predictors of ureteral stenosis after surgery in patients with upper ureteral incarcerated calculi.According to the comparison of predictive factors by ROC curve,the area under the curve(AUC)of ureteral wall thickness at the stone site was the largest(AUC=0.842,P<0.001),followed by the growth of ureteral polyps below the stone(AUC=0.685,P<0.001)and ureteral width above the stones(AUC=0.677,P<0.001).Conclusion:The ureteral width above the calculi,UWTmax and the growth of ureteral polyps below the stone are independent predictors of ureteral stricture after surgery in patients with upper ureteral incarcerated calculi.The best predictor is ureteral wall thickness at the calculi site,with an optimal predictive value of 2.595 mm,specificity of 88.6%and sensitivity of 74.5%.