输尿管上段结石患者输尿管软镜钬激光碎石术后输尿管狭窄的影响因素分析

Influencing Factors of Ureteral Stricture in Patients with Upper Ureteral Calculi after Ureteral Flexible Scope Holmium Laser Lithotripsy

目的调查输尿管上段结石患者在输尿管软镜钬激光碎石术后输尿管狭窄的发生率,分析其影响因素。方法回顾性选取昆山市中西医结合医院于2021年1月—2023年12月收治的274例输尿管上段结石患者的临床资料,所有患者均采用输尿管软镜钬激光碎石术进行治疗。根据是否发生输尿管狭窄为划分依据,将患者分为狭窄组(29例)与非狭窄组(245例),比较两组一般资料的差异性,并进行多因素Logistic回归分析。结果274例患者中,确诊为输尿管狭窄者29例,发生率为10.58%。单因素分析结果显示,两组患者的结石嵌顿、尿路感染、息肉包绕结石、手术时间、输尿管损伤、病程共6项指标对比,差异有统计学意义(P均<0.05)。多因素Logistic回归分析显示,结石嵌顿(OR=2.668,95%CI:1.023~6.963)、息肉包绕结石(OR=6.028,95%CI:2.328~15.612)、病程(OR=6.542,95%CI:2.407~17.779)及输尿管损伤(OR=4.083,95%CI:1.562~10.672)是患者术后输尿管狭窄的影响因素(P均<0.05)。结论输尿管上段结石患者软镜治疗后输尿管狭窄的风险较高,病程较长、息肉包绕、结石嵌顿以及输尿管损伤等可能增加狭窄风险,围术期管理与医疗决策应高度重视此类因素造成的影响。

Objective To investigate the incidence of ureteral stricture in patients with upper ureteral calculi after ureteral soft scope holmium laser lithotripsy and analyze its influencing factors.Methods The clinical data of 274 patients with upper ureteral calculi admitted to Kunshan Hospital of Integrated Traditional Chinese and Western Medicine from January 2021 to December 2023 were retrospectively selected.All patients were treated by ureteral soft lens holmium laser lithotripsy.According to whether ureteral stenosis occurred,the patients were divided into a narrow group(29 cases)and a non-narrow group(245 cases).The difference of general data between the two groups was compared,and multivariate Logistic regression analysis was performed.Results Among 274 patients,29 were diagnosed with ureteral stenosis(10.58%).The results of single factor analysis showed that there were statistically significant differences in 6 indexes of stone incarceration,urinary tract infection,polyp surrounding stone,operation time,ureteral injury and disease course between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that stone incarceration(OR=2.668,95%CI:1.023-6.963),polyp surrounding stone(OR=6.028,95%CI:2.328-15.612),disease course(OR=6.542,95%CI:2.407-17.779)and ureteral injury(OR=4.083,95%CI:1.562-10.672)were the influential factors for postoperative ureteral stenosis(all P<0.05).Conclusion Patients with upper ureteral calculi have a higher risk of ureteral stenosis after soft lens treatment,and the longer course of disease,polyp wrapping,stone incarceration,and ureteral injury may increase the risk of stenosis.Perioperative management and medical decisionmaking should attach great importance to the influence of these factors.