根治性子宫切除术后持续性输尿管狭窄的危险因素分析

Analysis of risk factors for ureteral stricture after radical hysterectomy

目的探讨根治性子宫切除术后患者出现持续性输尿管狭窄的相关危险因素,以指导临床的预防和治疗。方法回顾性分析2013年12月至2018年12月在广西医科大学附属肿瘤医院确诊为宫颈癌、子宫内膜癌需行根治性子宫切除术患者的临床病理资料,分析术后持续性输尿管狭窄的发生率和相关危险因素及对患者预后的影响。结果最终共有1068例患者纳入研究,其中194例患者在根治性子宫切除术后出现持续性的输尿管狭窄,总体发生率为18.2%,其中子宫颈癌的发生率为18.7%(151/807),子宫内膜癌的发生率为16.5%(43/261),两种类型肿瘤术后输尿管狭窄的发生率比较差异无统计学意义(P>0.05)。单因素分析显示,FIGO分期、术后辅助化疗、脉管浸润、淋巴结转移、术后辅助放疗、术后输尿管瘘、术后淋巴囊肿、术前白蛋白与根治性子宫切除术后出现持续性输尿管狭窄有关(均P<0.05);多因素分析显示:术后辅助放疗、术后辅助化疗、术后输尿管瘘、术后淋巴囊肿是其独立的危险因素(均P<0.05)。术后有、无持续性输尿管狭窄患者的生存率比较差异有统计学意义(P<0.01)。结论宫颈癌、子宫内膜癌患者行根治性子宫切除术后持续性输尿管狭窄的发生率较高,术后输尿管瘘、术后辅助放疗、术后辅助化疗、术后淋巴囊肿是其独立危险因素。术后持续性的输尿管狭窄可能影响患者的预后。

Objective To investigate the risk factors of postoperative persistent ureteral stricture by collecting and analyzing the clinical pathological data of patients after radical hysterectomy.Methods The clinicopathological data of patients with cervical cancer and endometrial cancer diagnosed in Guangxi Medical University Cancer Hospital from December 2013 to December 2018 who needed radical hysterectomy were retrospectively analyzed,and the incidence of postoperative persistent ureteral stricture,related risk factors and their impact on the prognosis of patients were analyzed.Results Finally,a total of 1068 patients were included in the study.Among them,194 patients developed persistent ureteral stricture after radical hysterectomy,with an overall incidence of 18.2%,of which the incidence of cervical cancer was 18.7%(151/807),and the incidence of endometrial cancer was 16.5%(43/261).There was no significant difference in the incidence of ureteral stricture after radical hysterectomy between the two types of tumors(P>0.05).Univariate analysis showed that International Federation of Obstetrics and Gynecology(FIGO)stage,postoperative adjuvant chemotherapy,vascular invasion,lymph node metastasis,postoperative adjuvant radiotherapy,postoperative ureteral fistula,postoperative lymphatic cyst,preoperative albumin were associated with persistent ureteral stricture after radical hysterectomy(all P<0.05);Multivariate analysis showed that postoperative adjuvant radiotherapy,postoperative adjuvant chemotherapy,postoperative ureteral fistula and postoperative lymphatic cyst were independent risk factors for persistent ureteral stricture(all P<0.05).There was a statistically significant difference in the survival rate between patients with and without persistent ureteral stricture(P<0.01).Conclusions The incidence of persistent ureteral stricture after radical hysterectomy is relatively high in patients with cervical cancer and endometrial cancer,and postoperative ureteral fistula,postoperative adjuvant radiotherapy,postoperative adjuvant chemotherapy and lymphocyst may be independent risk factors.Postoperative persistent ureteral stricture may affect the outcome of patients.