目的 探讨腔内钬激光碎石术后并发输尿管狭窄的相关性因素。方法 回顾分析近两年106例接受输尿管镜钬激光碎石(ureteroscopy holmium laser lithotripsy,URHL)及17例经皮肾输尿管镜钬激光碎石(percutaneous nephrolithotripsy,PCNL)手术治疗的患者,在URHL组的患者中通过统计学方法找出与术后输尿管狭窄有关的因素,并与PCNL组相应病例特征进行对照分析腔内钬激光治疗术后并发医源性输尿管狭窄的相关原因。结果 URHL病例术后发生输尿管狭窄甚至闭锁6例,狭窄率5.7%(6/106),PCNL术后未发生输尿管狭窄。URHL组病例分析发现结石的位置、大小、手术时间、耗水量对术后输尿管狭窄形成有统计学意义,而具备以上特征的患者接受PCNL手术后却没有出现输尿管狭窄。结论 输尿管结石的位置、直径,手术时间,耗水量,是URHL术后出现输尿管狭窄的相关因素,结石位置越高、直径越大、手术时间越久、耗水量越多的病例术后越容易发生输尿管狭窄。因而此类病例适宜采用PCNL术式来降低或避免该并发症的发生。
Objective To study the correlation factors of ureteral stenosis after Holmium laser lithotripsy in the cavity. Methods Retrospective analysis of 106 patients with surgical treatment of ureteroscopy Holmium laser lithotripsy(URHL)and 17 patients with surgical treatment of Percutaneous Nephrolithotripsy(PCNL)in the past 2 years.The factors associated with postoperative ureteral stenosis were identified by statistical methods in patients in the URHL group,and the related causes of iatrogenic ureteral stenosis after endoscopic Holmium laser therapy were analyzed by contrast with the corresponding case characteristics of PCNL group. Results There were 6 cases of ureteral stenosis and even atresia after operation in URHL group,the stenosis rate 5.7%(6/106), and ureteral stenosis did not occur after PCNL operation.The case analysis of URHL group found that the location,size,operation time and water consumption of the calculi were statistically significant for the formation of ureteral stenosis after operation,but the patients with the above characteristics did not appear ureteral stenosis after receiving PCNL operation. Conclusion The location,diameter,operation time and water consumption of ureteral calculi are the related factors of ureteral stenosis after URHL operation.With higher location and larger diameter of the calculi,longer operation time,and more water consumption,it is more likely to occur ureteral stenosis after operation.Therefore,it is appropriate to use PCNL in such cases to reduce or avoid the occurrence of this complication.
Sichuan Medical Journal