输尿管镜下碎石术后输尿管狭窄多因素分析及预防策略

Multi-factor analysis and preventive strategies of ureteral stricture after ureteral calculi treated with ureteroscopic lithotripsy

目的探讨输尿管镜下碎石术治疗输尿管结石术后输尿管狭窄多因素分析及预防策略.方法回顾性分析2013年1月-2019年12月本院收治的838例输尿管结石患者的临床资料,均行输尿管镜下碎石术,术后观察总结患者发生输尿管狭窄的发生率及影响因素.结果838例患者均输尿管镜下碎石成功,术后复查共出现输尿管狭窄28例(3.34%),其中输尿管闭锁12例(1.43%).结论输尿管结石术后输尿管狭窄原因复杂,其中术前结石长期嵌顿,重度肾积水及较大结石患者输尿管镜碎石术后发生输尿管狭窄风险明显升高,而术中医疗器械机械损伤、钬激光对输尿管黏膜热损伤及损伤后炎症反应、纤维化亦提高了输尿管狭窄的风险,预防措施应以平素提高患者对输尿管结石风险意识,术中对各种细节把控预防输尿管损伤、定期复查及时处理等综合预防措施为主.

Objective To explore the multi-faclor analysis and preventive strategies of ureteral stricture after ureleral calculi Irealerl with urelerosropic1 lithotripsy.Methods A retrospective analysis of the clinical data of 838 palienls with ureteral calculi admitted to our hospital from January 2013 to December 2019,all underwent urelerosoopic litholripsy.Postoperative observation and summary of the orfurrenre of ureteral stenosis in patients Rale and influencing factors.Results All 838 patients were surressful in lithotripsy under ureterosropy,28 rases(3.34%)had ureleral stricture after reexamination,of which 12 rases(1.43%)were ureleral atresia.Conclusion The causes of ureteral stenosis after ureteral ralruli are complicated,including long-term incarceration of preoperative stones,severe hydronephrosis,and larger stones.The risk of ureteral stenosis after ureterosropir lithotripsy is signifiranlly increased.Intraoperative medical equipment mechanical damage,holmium laser Heal injury to the ureleral mucosa and post-injury inflammatory reaction and fibrosis also increase the risk of ureteral stricture.Preventive measures should be taken to improve the patient's awareness of the risk of ureleral slones.Various details during the operation are rontrollerl to prevent ureleral injury,regular review and timely treat ment Comprehensive preventive measures.