单发输尿管结石患者行输尿管镜下钬激光碎石术后狭窄的危险因素分析

Analysis of risk factors for postoperative stenosis with single ureteral calculi treated with ureteroscopic holmium laser listhotripsy

目的探讨单发输尿管结石患者行输尿管镜下钬激光碎石(URSL)后发生狭窄的危险因素,为患者的治疗提供参考。方法回顾性分析2017年11月至2018年11月在本院行URSL术的单发输尿管结石患者230例,按照术后随访结果将其中输尿管狭窄患者26例作为观察组,输尿管非狭窄患者204例作为对照组,分析患者术后发生狭窄的危险因素。结果结石直径≥2 cm、严重肾积水、结石嵌顿、病程较长均是患者术后发生狭窄的危险因素,两组比较差异有统计学意义(P<0.05);输尿管狭窄多因素logistic回归分析显示,大结石、严重肾积水、嵌顿结石以及长病程均是影响患者URSL术后输尿管狭窄的独立危险因素,差异有统计学意义(P<0.05)。结论严重肾积水、结石较大、结石嵌顿以及较长病程均是患者术后发生输尿管狭窄的高危因素,因此在对患者进行治疗的过程中应远离引起患者输尿管狭窄的高风险因素,提高患者治疗效果。

Objective To explore the risk factors of stricture after ureteroscopic holmium laser lithotripsy(URSL)in patients with single ureteral calculi,and to provide reference for the treatment of patients.Methods Retrospective analysis of 230 patients with single ureteral calculi who underwent URSL between November 2017 and November 2018 was performed.According to the postoperative follow-up results,26 patients with ureteral stricture were treated as observation group,and ureteral non-stenosis patients were 204 patients as a control group.The risk factors for stenosis after surgery were analyzed.Results The risk factors of postoperative stenosis showed that the diameter of calculus≥2 cm,severe hydronephrosis,stone incarceration,and long course of disease were the risk factors for postoperative stenosis.The difference between the two groups was statistically significant(P<0.05).Multivariate logistic regression analysis of ureteral stricture showed that large stones,severe hydronephrosis,incarcerated stones and long-term disease were independent risk factors for ureteral stricture after URSL,and the difference was statistically significant(P<0.05).Conclusions Severe hydronephrosis,large stones,stone incarceration and long course of disease are high risk factors for postoperative ureteral stricture.Therefore,patients should be kept away from the high risk factors causing ureteral stricture in patients during treatment for better therapeutic efficiency.