输尿管狭窄在输尿管结石输尿管镜钬激光碎石术后患者中的发生情况及其危险因素研究

Occurrence and Risk Factors of Ureteral Stricture in Patients with Ureteral Calculi after Ureteroscopic Holmium Laser Lithotripsy

目的探讨输尿管结石输尿管镜钬激光碎石(Ureteroscopic Holmium Laser Lithotripsy,URHL)术后患者输尿管狭窄的发生情况及其影响因素。方法方便选取2020年1月—2023年3月印江县人民医院泌尿外科收治的246例输尿管结石患者为研究对象,所有患者均接受URHL治疗。按照术后是否存在输尿管狭窄分为狭窄组(14例)、非狭窄组(232例)。统计两组患者的临床资料,对其进行单因素、多因素分析,以筛选输尿管结石URHL术后患者发生输尿管狭窄的危险因素。结果单因素分析结果显示,狭窄组中病程≥3个月、结石直径>2 cm、存在息肉包裹、存在嵌顿结石、激光碎石时间>60 min的患者占比均显著高于非狭窄组,差异有统计学意义(P均<0.05);多因素Logistic回归分析结果显示,病程≥3个月、结石直径>2 cm、存在息肉包裹、存在嵌顿结石、激光碎石时间>60 min均为输尿管结石URHL术后患者发生输尿管狭窄的危险因素,差异有统计学意义(OR=2.349、2.004、3.384、3.600、4.166,P均<0.05)。结论病程≥3个月、结石直径>2 cm、存在息肉包裹、存在嵌顿结石、激光碎石时间>60 min均为输尿管结石URHL术后患者发生输尿管狭窄的危险因素,根据上述结果给予高危患者针对性干预措施,进而降低输尿管狭窄的发生风险。

Objective To investigate the occurrence and influencing factors of ureteral stricture after ureteroscopic holmium laser lithotripsy(URHL).Methods A total of 246 patients with ureteral calculi admitted to the Department of Urology of Yinjiang County People's Hospital from January 2020 to March 2023 were conveniently selected and treated with URHL.According to the presence or absence of ureteral stenosis,the patients were divided into stenosis group(14 cases)and non-stenosis group(232 cases).The clinical data of the two groups were analyzed,and univariate and multivariate analyses were performed to screen the risk factors of ureteral stricture in patients with ureteral calculi after URHL.Results Univariate analysis showed that the proportion of patients with disease course≥3 months,stone diameter>2 cm,polyp encapsulation,incarcerated stones,laser lithotripsis time>60 min in the stenosis group were significantly higher than that in the non-stenosis group,and the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that duration≥3 months,stone diameter>2 cm,polyp encapsulation,incarcerated stones,and laser lithotripsy time>60 min were all risk factors for ureteral stricture after URHL,and the differences were statistically significant(OR=2.349,2.004,3.384,3.600,4.166,all P<0.05).Conclusion Duration≥3 months,stone diameter>2cm,polyp encapsulation,incarcerated stones,and laser lithotripsy time>60 min are all risk factors for ureteral stricture in patients with URHL.Targeted interventions can be given to high-risk patients according to the above results,so as to reduce the risk of ureteral stricture.