输尿管通道鞘安置相关影响因素的分析

Analysis of related factors of ureteral access sheath placement

目的:探讨广西患者行输尿管软镜术,术中影响输尿管通道鞘(ureteral access sheath,UAS)安置的可能因素。方法:回顾分析广西医科大学第一附属医院泌尿外科2018年1月~2019年10月期间行输尿管软镜术的广西患者的病历资料,据术中放置UAS情况,将患者分成两组,分析两组的性别、年龄、身高、体重指数、结石位置、是否孤立肾、有无排石史、是否预置输尿管支架、既往同侧是否有腔镜手术或放置输尿管支架病史、手术侧别等指标,分析其与成功放置UAS的相关性。结果:本次纳入研究的患者共1093例,成功安置UAS的1016例(93%),安置失败的77例(7%);数据采用多因素二元logistic回归分析显示:有术前输尿管支架、有同侧腔镜手术或安置输尿管支架病史、结石位置等变量均有统计学意义(P<0.05)。结论:术前输尿管支架的置入、同侧上尿路腔镜手术或置入输尿管支架病史、肾结石以及肾结石并同侧输尿管结石等患者,术中UAS安置成功率较高,可以考虑不用常规术前安置双J管。

Objective:To explore the possible factors that affect the successful placement of ureteral access sheath(UAS)in patients from Guangxi province undergoing retrograde intrarenal surgery.Methods:The medical records of 1093patients of Guangxi nationality who underwent flexible ureteroscopy in urology department of First Affiliated Hospital of Guangxi Medical University from January 2018to October 2019were retrospectively ana-lysed.According to the situation of placing UAS during the operation,the patients were divided into two groups.The gender,age,height,body mass index,stone location,solitary kidney,history of stone removal,placement of ureteral stent,history of endoscopic surgery or ureteral stent placement on the same side in the past,and opera-tion side of the two groups were analyzed,and whether these factors were related to the successful placement of UAS was observed.Results:A total of 1093patients were included in the study,of which 1016(93%)were suc-cessfully placed with UAS,and 77(7%)failed to be placed.Multivariate logistic regression analysis showed that the variables such as preoperative ureteral stent,ipsilateral endoscopic surgery or history of ureteral stent place-ment,stone location were statistically significant(P<0.05).Conclusion:The success rate of UAS placement in patients with preoperative ureteral stent placement,upper urinary tract endoscopic surgery or history of ureteral stent placement,kidney stones and kidney stones with ureteral stones on the same side is high,so it is suggested that double-J stent should not be placed conventionally before operation.