Clinical efficacy and influencing factors of transurethral balloon dilatation in the treatment of ureteral stricture
-
摘要: 目的:观察经尿道途径输尿管球囊扩张术治疗输尿管良性狭窄的临床疗效,分析对预后可能存在的影响因素。方法:回顾性分析87例输尿管良性狭窄行经尿道途径输尿管球囊扩张术后的临床疗效,同时分别从年龄、部位、狭窄数量、狭窄长度、肾积水程度、留置输尿管支架管数量及时间、狭窄病因等方面评估影响手术效果的可能因素。结果:所有病例均顺利完成手术,无严重并发症。随访手术总体有效率为71.26%。年龄、部位、留置输尿管支架管数量对手术疗效无明显影响(P>0.05)。而输尿管狭窄数量及长度为影响行经尿道球囊扩张术后成功的不利因素(P<0.05),OR值为8.366和7.304。轻度肾积水较重度肾积水手术效果更好(P<0.05),OR值为0.179。相对于非医源性原因所造成的狭窄,医源性狭窄为手术效果的不利因素(P<0.05),OR值为5.045。结论:经尿道途径输尿管球囊扩张术是治疗输尿管良性狭窄行之有效的方法之一,临床医师可根据患者的临床情况评估球囊扩张术的适应证,保证临床疗效。Abstract: Objective: To observe the clinical curative effect of transurethral balloon dilatation for treatment of benign ureteral stricture, and analyze the possible influencing factors on the prognosis.Methods: We retrospectively analysed 87 cases of benign ureteral stricture undergoing ureteral balloon dilatation via transurethral route. At the same time, the possible factors affecting the surgical effect were evaluated from age, number of stricture, location of stricture, length of stricture, hydronephrosis, number and time of ureteral stents.Results: All cases were completed surgery successfully without serious complications. The overall effective rate was 71.26%. Age, location and quantity of indwelling ureteral stents had no significant effect on the operative efficacy(P>0.05). The quantity and length of ureteral stricture were adverse factors for the success of transurethral balloon dilatation(P<0.05), OR was 8.366 and 7.304. The treatment effect of mild hydronephrosis was better than that of severe hydronephrosis, OR was 0.179. Compared with other causes of stricture, iatrogenic causes obtained worse surgical effect(P<0.05), OR was 5.045.Conclusion: Transurethral ureteral balloon dilatation is one of the effective methods for the treatment of benign ureteral stricture. In order to guarantee the clinical curative effect, the clinician may evaluate the indication of balloon dilatation according to the patient's clinical situation.
-
Key words:
- ureteral stricture /
- balloon dilatation /
- effect /
- influencing factor
-
-
[1] 李柳林,孔垂泽,刘贤奎,等.输尿管镜下逆行球囊扩张术治疗良性输尿管狭窄的临床研究[J/OL].中华腔镜泌尿外科杂志(电子版),2019,13(2):85-90.
[2] 郝强.经尿道不同腔镜技术治疗输尿管狭窄的效果分析[J].西部医学,2011,23(6):1075-1076.
[3] 王向阳,姬彤宇,单磊.输尿管镜下逆行球囊扩张术治疗输尿管狭窄83例临床分析[J].临床泌尿外科杂志,2017,32(3):200-204.
[4] 郁华亮,叶林阳,杨渝,等.经皮肾穿刺顺行法球囊扩张术治疗良性输尿管狭窄[J].南方医科大学学报,2010,30(9):2212-2214.
[5] Seseke F,Heuser M,Zöller G,et al.Treatment of iatrogenic postoperative ureteral strictures with Acucise endoureterotomy[J].Eur Urol,2002,42(4):370-375.
[6] Oh SJ,Jeong BC,Kim HH.Ureteroenteric fistula after retrograde balloon dilatation of ureteral stricture[J].Int J Urol,2002,9(12):707-709.
[7] 周林玉,曹正国,肖峻,等.腹膜外腹腔镜下输尿管膀胱再植治疗输尿管下段狭窄32例报告[J].安徽医学,2009,30(1):35-36.
[8] 乔勇,徐月敏,吴登龙,等.抗返流技术的回肠代输尿管治疗长段输尿管狭窄[J].中华泌尿外科杂志,2007,28(3):206.
[9] Savenkov VI,Pavlov SB.Changes of the cytokines profile in patients with hydronephrosis and indicated operative treatment[J].Klin Khir,2014,11(11):58-61.
[10] 王法鹏,殷积斌,张仁科,等.置放输尿管支架管的并发症[J].中华外科杂志,2003,41(10):794.
[11] 吴佳成,姜力,陆雅君.经尿道输尿管镜治疗输尿管结石后发生输尿管狭窄的危险因素分析[J].国际泌尿系统杂志,2019,39(3):505-509.
[12] Mugiya S,Ito T,Maruyama S,et al.Endoscopic features of impacted ureteral stones[J].J Urol,2004,171(1):89-91.
[13] 刘跃闻,李建中,周亚军,李昕.输尿管镜钬激光碎石术后继发输尿管狭窄的危险因素分析[J].临床泌尿外科杂志,2019,34(8):621-624.
[14] Liatsikos EN,Karnabatidis D,Katsanos K,et al.Ureteral metal stents:10-year experience with malignant ureteral obstruction treatment[J].J Urol,2009,182(6):2613-2617.
[15] 薛蔚.医源性损伤致输尿管梗阻形成的临床研究[D].江苏:苏州大学,2010.
[16] Richter F,Irwin RJ,Watson RA,et al.Endourologic management of benign ureteral strictures with and without compromised vascular supply[J].Urology,2000,55(5):652-657.
[17] Srougi V,Padovani GP,Marchini GS,et al.Outcomes of surgical treatment of ureteral strictures after laser ureterolithotripsy for impacted stones[J].Can J Urol,2015,22(6):8079-8084.
[18] 刘杰,王伟,胡雪辉,等.腔内两根双J管治疗单根双J管无效的良性输尿管狭窄疗效观察[J].国际泌尿系统杂志,2017,37(4):536-539.
-
计量
- 文章访问数: 1320
- PDF下载数: 2294
- 施引文献: 0
下载: