输尿管镜下逆行球囊扩张术治疗输尿管狭窄83例临床分析

Clinical analysis of 83 cases of ureteral stricture treated by retrograde balloon dilatation in ureteroscope

目的:探讨输尿管镜下逆行球囊扩张术治疗输尿管狭窄的临床疗效。方法:回顾性分析我院2010年2月~2016年2月期间逆行球囊扩张术治疗输尿管狭窄的83例临床资料,其中男45例,女38例,年龄22~70岁,平均46岁;均为输尿管单发狭窄,其中左侧37例,右侧46例;狭窄段位于肾盂-输尿管连接处3例,上段21例,中段25例,下段34例;狭窄段长度0.5~2.5cm,应用逆行球囊导管扩张狭窄段输尿管,术后留置2根F_(4.7)输尿管支架管,3个月后拔除。结果:手术时间30~60min,平均43.5min,术后住院3~6d,平均4.5d,术后无严重并发症发生。术后78例患者随访时间达6个月,其中治愈、好转和无效患者分别为42例(53.8%)、28例(35.9%)和8例(10.3%)。术后67例患者随访时间达24个月,其中治愈、好转和无效患者分别为19例(28.4%)、27例(40.3%)和21例(31.3%)。卡方检验及多分类Logistic回归分析结果均显示,患者的年龄、输尿管狭窄位置对手术预后疗效无显著影响(P>0.05);输尿管狭窄段长度、狭窄持续时间和肾盂积水程度均显著影响预后疗效(P<0.05)。结论:逆行球囊扩张术是一种安全、有效的微创治疗方式,在严格把握适应证的同时,可作为临床上治疗良性输尿管狭窄的首选方式,但其远期疗效仍有待进一步观察。

Objective：To investigate the efficiency of retrograde balloon dilatation for treating ureteral stricture in ureteroscope.Method：A retrospective analysis of 83 cases who received treatment in the hospital from February 2010 to February 2016 was done.There were 45 males and 38 females whose average age was 46 years old.All the patients were diagnosed with single ureteral stricture,37 of them were at the left side while 46 at the right.There were three cases whose narrow segment located at the junction of the renal pelvis and ureter,21 at the upper ureter,25 at the middle part and 34 at the lower part.The length of the ureteral stricture ranged from 0.5cm to2.5cm.Retrograde balloon catheter was used to dilate the constrictive part of ureter.Two ureteral stents of F4.7size were retained after surgery for three months.Result：The operation time ranged from 30 min to 60 min with a mean of 43.5min.Hospitalization time after the surgery ranged from 3dto 6dwith a mean of 4.5d.No severe complication was detected during or after the surgery.Seventy-eight patients were followed up for six months,among whom 42cases（53.8%）,28cases（35.9%）and 8cases（10.3%）were cured,improved and ineffective respectively.Sixty-seven patients were followed up for 24 months,among whom 19cases（28.4%）,27cases（40.3%）and 21cases（31.3%）were cured,improved and ineffective respectively.Chi-square test and multiple logistic regression analysis showed that there was no significant effect of age or position of the ureteral stricture on the prognosis of surgery（P〉0.05）,while on the contrary,length and duration of ureteral stricture along with degree of renal pelvis had markedly effect on it（P〈0.05）.Conclusion：Retrograde balloon dilatation is a kind of safe and effective minimally invasive treatment.According to the indication,it can be used as the first choice for the treatment of benign ureteral stricture.However,its long-term efficiency still needs to be further observed.