钬激光碎石后发生输尿管狭窄的病因及临床意义

Basic study and clinical significance of ureteral stricture after holmium laser lithotripsy

目的探讨钬激光碎石后发生输尿管狭窄的病因,为临床治疗及预防提供指导意义。方法回顾性分析2020年5月至2022年5月在本院诊断为输尿管结石的482例患者的临床资料,其中65例行后腹腔镜输尿管切开取石术,417例行输尿管镜钬激光碎石术。对正常输尿管行HE染色,提取输尿管平滑肌细胞并用钬激光处理,采用Transwell实验检测其对巨噬细胞的趋化作用,采用Western blot法检测α-平滑肌肌动蛋白(α-SMA)的表达情况。结果输尿管镜钬激光碎石术后的输尿管狭窄发生率高于后腹腔镜输尿管切开取石(P=0.008)。机制上碎石过程中钬激光可造成输尿管平滑肌细胞损伤,促进巨噬细胞迁移并诱导其高表达α-SMA。结论钬激光碎石容易造成输尿管平滑肌细胞损伤,招募巨噬细胞参与纤维化过程,导致输尿管狭窄,术中尽量避免肌层的损伤及减少巨噬细胞的浸润有助于减少输尿管狭窄的发生。

Objective To investigate the etiology of ureteral stricture after holmium laser lithotripsy,and to provide guidance for clinical treatment and prevention.Methods The clinical data of 482 patients diagnosed with ureteral calculi in our hospital from May 2020 to May 2022 were retrospectively analyzed.Among them,65 patients underwent retroperitoneal laparoscopic ureterolithotomy and 417 patients underwent ureteroscopic holmium laser lithotripsy.The normal ureter was stained with HE,and the ureteral smooth muscle cells were extracted and treated with holmium laser.Transwell assay was used to detect the chemotaxis of macrophages,and Western blot was used to detect the expression ofα-smooth muscle actin(α-SMA).ResultsThe incidence of postoperative ureteral stricture was higher than in retroperitoneal laparoscopic ureterotomy,and the difference was statistically significant(P=0.008).Mechanically,holmium laser damage ureteral smooth muscle cells during lithotripsy promotes macrophage migration and induces high expression ofα-SMA.Conclusions Holmium laser lithotripsy is easy to cause ureteral smooth muscle cell injury and recruit macrophages to participate in the fibrosis process,resulting in ureteral stricture.During operation,muscle layer injury should be avoided as much as possible and macrophages infiltration should be reduced,which is helpful to reduce occurrence of ureteral stricture.