输尿管上段嵌顿性结石术后发生输尿管狭窄的影响因素分析

doi:10.19558/j.cnki.10-1020/r.2020.05.008

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摘要 目的：探讨输尿管上段嵌顿性结石术后发生输尿管狭窄的影响因素。方法：回顾性分析443例输尿管上段嵌顿性结石患者的临床资料,比较术后有否发生输尿管狭窄患者的性别、年龄、结石位置、结石大小、结石CT值、术前肾积水程度、结石以上输尿管宽度、结石所在部位输尿管壁厚度（UWT_max）及结石周围输尿管息肉生长情况。采用多因素logistic回归分析筛选术后发生输尿管狭窄的独立预测因子;采用ROC曲线比较各指标在预测输尿管上段嵌顿性结石术后发生输尿管狭窄方面的价值。结果：术后发生输尿管狭窄患例者57例,未发生386例。单因素分析结果为,输尿管狭窄与非狭窄患者的UWT_max、结石以上输尿管宽度、结石周围输尿管伴息肉及术前肾积水程度的差异有统计学意义（P<0.05）,而性别、年龄、结石位置、结石大小、结石CT值差异无统计学意义（P>0.05）。多因素分析结果为,结石以上输尿管宽度(Wals=11.530,OR=1.159,95％CI：1.064~1.262,P<0.001)、UWT_max(Wals=39.276,OR=15.543,95％CI：6.590~36.657,P<0.001)及结石周围输尿管伴息肉生长（Wals=13.331,OR=0.117,95％CI：0.037~0.370,P<0.001）是输尿管上段嵌顿性结石患者术后发生输尿管狭窄的独立预测因素。ROC曲线对预测因素的比较结果显示,结石部位输尿管壁厚度的曲线下面积(AUC)最大(AUC=0.842,P<0.001),其次为结石周围输尿管伴息肉生长(AUC=0.685,P<0.001)及结石以上输尿管宽度(AUC=0.677,P<0.001)。结论：结石以上输尿管宽度、UWT_max和结石周围输尿管伴息肉生长是输尿管上段嵌顿性结石患者术后是否发生输尿管狭窄的独立预测因素,其中预测能力最佳的是结石部位输尿管壁厚度,最佳预测值2.595 mm,特异性88.6%,敏感性74.5%。

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关键词 ：预测因子, 嵌顿性结石, 输尿管结石, 输尿管壁厚度

Abstract：Objective： To investigate the influencing factors of postoperative ureteral stricture in patients with upper ureteral incarcerated stones. Methods： A retrospective study was performed on the clinical data of 461 patients with upper ureteral incarcerated calculi who underwent surgery in our hospital from January 1, 2014 to January 1, 2019. The gender, age, stone location, stone size, CT value of the stones, preoperative hydronephrosis, ureteral width above the stones, maximum ureteral wall thickness at the stone site （UWT_max） and the growth of ureteral polyps below the stone were compared between the two groups of patients with ureteral stricture and no ureteral stricture. Multivariate logistic regression analysis was used to screen the independent predictors of postoperative ureteral stenosis. The ROC curve was used to compare the value of each index in predicting ureteral stenosis after operation in patients with upper ureteral incarcerated calculi. Results： Among the 461 cases of upper ureteral incarcerated calculi, 57 cases had ureteral stricture, 386 cases had no ureteral stricture, and 18 cases were lost to follow-up. Single-factor analysis showed that there were statistically significant differences in UWT_max, ureteral width above the calculi, the growth of ureteral polyps below the stone and degree of hydronephrosis between the two groups （P <0.05）, and there were no statistically significant differences in gender, age, calculi location, calculi size and calculi CT value between two groups （P >0.05）. Multivariate logistic regression analysis showed that the ureteral width above calculi （Wald value = 11.530, OR = 1.159, 95% CI 1.064-1.262, P <0.001）, UWT_max （Wald value = 39.276, OR =15.543, 95% CI 6.590-36.657, P <0.001） and the growth of ureteral polyps below the stone （Wald value =13.331, OR = 0.117, 95% CI 0.037-0.370, P <0.001） were independent predictors of ureteral stenosis after surgery in patients with upper ureteral incarcerated calculi. According to the comparison of predictive factors by ROC curve, the area under the curve （AUC） of ureteral wall thickness at the stone site was the largest （AUC = 0.842, P <0.001）, followed by the growth of ureteral polyps below the stone （AUC = 0.685, P <0.001） and ureteral width above the stones （AUC = 0.677, P <0.001）. Conclusion： The ureteral width above the calculi, UWTmax and the growth of ureteral polyps below the stone are independent predictors of ureteral stricture after surgery in patients with upper ureteral incarcerated calculi. The best predictor is ureteral wall thickness at the calculi site, with an optimal predictive value of 2.595 mm, specificity of 88.6% and sensitivity of 74.5%.

Key words： predictors incarcerated calculus ureterolithiasis ureteral wall thickness

收稿日期: 2019-10-20

通讯作者: 许长宝,xcb1966@126.com

引用本文:

万优, 许长宝, 赵兴华, 王晓甫, 刘昌伟, 吕远. 输尿管上段嵌顿性结石术后发生输尿管狭窄的影响因素分析[J]. 微创泌尿外科杂志, 2020, 9(5): 324-329.
WAN You, XU Changbao, ZHAO Xinghua, WANG Xiaofu, LIU Changwei, LYU Yuan. Analysis of influencing factors of postoperative ureteral stricture in patients with upper ureteral incarcerated stones. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(5): 324-329.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1622.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2020/V9/I5/324

[1] SARICA K, KAFKASLI A, YAZICI Ö, et al.Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL. UIolithiasis, 2015,43:83-88.
[2] GOEL R, ARON M, KESARWANI PK, et al.Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol, 2005,19(1):54-57.
[3] ELIBOL O, YALCIN SK, AYSE B, et al.Radiological non-invasive assessment of ureteral stone impaction into the ureteric wall: A critical evaluation with objective radiological parameters. Investig Clin Urol, 2017,58(5):339-345.
[4] DEGIRMENCI T, GUNLUSOY B, KOZACIOGLU Z, et al.Outcomes of ureteroscopy for the management of impacted ureteral calculi with different localizations. Urology, 2012,80(4):811-815.
[5] SEITZ C, TANOVIC E, KIKIC Z, et al.Editorial comment on: Impact of stone size, location, composition, impaction, and hydronephrosis on the efficacy of holmium: YAG-laser ureterolithotripsy. Eur Urol, 2007,52(6):1758-1759.
[6] 王俊,郭志新,吴洪磊,等.输尿管软镜钬激光碎石术治疗输尿管上段结石并发输尿管狭窄的危险因素分析.临床泌尿外科杂志,2018,33(7):532-536.
[7] WANG Y, ZHONG B, YANG X, et al.Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol, 2017,17(1):50.
[8] 许清江,叶烈夫,朱庆国,等.输尿管壁厚度对嵌顿性输尿管结石的预测价值.中华泌尿外科杂志,2019,40(3):210-214.
[9] 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.中华腔镜泌尿外科杂志(电子版),2019,13(2):85-90.
[10] YOSHIDA T, INOUE T, OMURA N, et al.Ureteral wall thickness as a preoperative indicator of impacted stones in patients with ureteral stones undergoing ureteroscopic lithotripsy. Urology, 2017,106(106):45-49.
[11] MUGIYA S, ITO T, MARUYAMA S, et al.Endoscopic features of impacted ureteral stones. J Urol, 2004,171(1):89-91.
[12] SARICA K, ERYILDIRIM B, SAHIN C, et al.Impaction of ureteral stones into the ureteral wall: Is it possible to predict? Urolithiasis, 2016,44(4):371-376.
[13] SUN X, XIA S, LU J, et al.Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. J Endourol, 2008,22(5):913-917.
[14] JUAN YS, SHEN JT, LI CC, et al.Comparison of percutaneous nephrolithotomy and ureteroscopic lithotripsy in the management of impacted, large, proximal ureteral stones. Kaohsiung J Med Sci, 2008,24(4):204-209.
[15] MANOHAR T, GANPULE A, DESAI M.Comparative evaluation of Swiss LithoClast 2 and Holmium: YAG laser lithotripsy for impacted upper-ureteral stones. J Endourol, 2008,22(3):443-446.
[16] KHALIL M.Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with Holmium: YAG laser lithotripsy. Urol Ann, 2013,5(2):88-92.
[17] 李聪,王少刚.体外冲击波碎石治疗后清石率的影响因素.中华泌尿外科杂志,2018,39(9):718-720.
[18] LOPES NETO AC, KORKES F, SILVA JL, et al.Prospective randomized study of treatment of large proximal ureteral stones: extracorporeal shock wave lithotripsy versus ureterolithotripsy versus laparoscopy. J Urol, 2012,187(1):164-168.
[19] WU CF, SHEE JJ, LIN WY, et al.Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium: YAG laser lithotripsy for treating large proximal ureteral stones. J Urol, 2014,172(5 Pt 1):1899-1902.
[20] 王成路,金露,薛波新.术前预测输尿管嵌顿性结石的临床因素分析.中华泌尿外科杂志,2019,40(1):42-46.
[21] BOZKURT IH, YONGUC T, ARSLAN BA, et al.Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy? CUAJ, 2015,9(3/4):E122-E125.
[22] 杨磊,蒋立,唐伟.一期输尿管软镜钬激光碎石术治疗输尿管结石合并输尿管迂曲的疗效观察.中华泌尿外科杂志,2019,40(7):537-540.
[23] CHIH SC, CHING FW, SHEE JJ, et al.Holmium: YAG lasertripsy with semirigid ureterorenoscope for Upper-Ureteral stones >2 cm. J Endourol, 2005,19(7):780-784.
[24] LEGEMATE JD, WIJNSTOK NJ, MATSUDA T, et al.Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones. World J Urol, 2017,35(10):1497-1506.
[25] FAM XI, SINGAM P, HO CCK, et al.Ureteral stricture formation after ureteroscope treatment of impacted calculi: a prospective study. Korean J Urol, 2015,56(1):63-67.
[26] 吕远,许长宝,马静,等.“一步法”输尿管软镜治疗嵌顿性输尿管上段结石的临床分析.中华泌尿外科杂志,2017,38(5):371-374.
[27] YASUI T, OKADA A, HAMAMOTO S, et al.Efficacy of retroperitoneal laparoscopic ureterolithotomy for the treatment of large proximal ureteric stones and its impact on renal function. Springerplus, 2013,2:600.
[28] NOUIRA Y, KALLEL Y, BINOUS MY, et al.Laparoscopic retroperitoneal ureterolithotomy: initial experience and review of literature. J Endourol, 2004,18(6):557-561.
[29] 曹文锋,王亮,黄晓科,等.微创经皮肾镜联合输尿管软镜治疗嵌顿性输尿管上段结石.中国微创外科杂志,2012,12(10):933-934,937.
[30] KARAMI H, ARBAB AH, HOSSEINI SJ, et al.Impacted upper-ureteral calculi > 1 cm: Blind access and totally tubeless percutaneous antegrade removal or retrograde approach? J Endourol, 2006,20(9):616-619.