输尿管镜下钬激光碎石术致输尿管损伤的原因及防治

Ureteral Injuries after Holmium∶YAG Laser Ureteroscopic Lithotripsy for Ureteral Calculi:Predictive Factors,Treatment and Prevention

目的探讨输尿管镜下钬激光碎石术致输尿管损伤的原因和防治措施。方法对2002年5月至2007年5月656例输尿管镜下钬激光碎石术进行了回顾性研究。按手术时间段依次分成4个组。应用多变量Logistic回归分析模式,分析患者年龄、性别,结石大小、结石位置以及术者经验对输尿管损伤率的影响。结果全组656例手术,总的输尿管损伤率3.5%,发生输尿管穿孔20例,输尿管黏膜不完全撕脱2例,输尿管黏膜下假道1例。多变量分析表明术者手术经验与输尿管损伤发生率有统计学意义(P<0.05)。结论输尿管镜下钬激光碎石术致输尿管损伤低发生率与手术者的经验显著相关;患者性别、年龄,结石位置、大小与手术致输尿管损伤率无明显相关性。

Objective To define possible predictive factors for ureteral injuries after holmium ： YAG laser ureteroscopic lithotripsy for ureteral calculi and discuss how to prevent and reduce injuries. Methods All 656 ureteroseopic holmium ： YAG laser lithotripsy procedures performed between 2002 and 2007 were analyzed. Data recorded were about sex, age, stone size, stone location, ureteral injuries rate, and surgeon experience for this procedure. For further analysis, surgeon experience was divided into four groups based on the period of procedures performed. Multivariate analysis was used to define possible predictive factors for ureteral injuries. Results Of all the cases, ureteral injuries were present in 23 patients （3.5%）. Ureteral injuries rate was significantly （ P 〈 0.05 ） related to surgeon experience. In our series, sex, age, stone location and size did not significantly influence ureteral injuries rates. Conclusions Surgeon experience is a predictive factor for ureteral injuries after ureteroseopic holmium ： YAG laser lithotripsy for ureteric calculi. Experienced surgeons have fewer ureteral injuries. The patient＇s sex, stone location, size, and age are not significantly related to ureteral injuries.