输尿管结石行输尿管镜下碎石术后并发输尿管狭窄的危险因素分析

Analysis of the risk factors of ureterostenosis after ureteroscopic lithotripsy in patients with ureteral calculi

目的探讨输尿管镜下治疗输尿管结石术后并发输尿管狭窄的危险因素。方法以2014年1月至2015年12月间来我院就诊的708例行输尿管镜下碎石的输尿管结石患者的临床资料为基础,分析造成术后输尿管狭窄的危险因素。结果术后共发现输尿管狭窄患者36例(5.1%)。导致输尿管狭窄发生的危险因素依次为:嵌顿结石(OR=3.61,95%CI=2.12~6.08,P<0.001)、多发结石(OR=3.22,95%CI=1.01~5.77,P<0.001)、大结石(OR=2.41,95%CI=1.14~4.18,P<0.001)、钬激光手术(OR=1.36,95%CI=1.02~3.93,P=0.031),长病程(OR=1.12,95%CI=1.02~3.42,P=0.038)。结论对于嵌钝性结石、多发结石、结石较大及行钬激光碎石者,应注意手术操作对输尿管的损伤,积极防治输尿管狭窄的发生。

Objective To investigate the risk factors of ureteral stricture after ureteroscopic lithotripsy in patients with ureteral calculi. Methods The risk factors ofureteral stricture after ureteroscopic lithotripsy based on the clinical data of 708 patients from January 2014 to December 2015 in our hospital were analyzed retrospectively. Results A total of 36 patients （5.1%） with ureteral stricture were found. The risk factors for the ureteral stricture were： impacted calculi （OR=3.61, 95%CI=2.12-6.08, P〈0.001）, multiple calculi（OR=3.22, 95%CI=1.01-5.77, P〈0.001）, big stone（OR=2.41, 95%CI=1.14-4.18, P〈0.001）, holmium laser lithotripsy （OR=1,36, 95%CI=1.02-3.93, P=0,031）, long course of disease （OR=1.12,95%CI=1. 02-3.42, P=0.038）. Conclusion For patients with impacted calculi, multiple stones, large stones and patients who were treated with holmium laser lithotripsy, we should be careful not to injury the ureter, and actively prevent and control the occurrence ofureteral stenosis