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

doi:10.3877/cma.j.issn.1674-3253.2019.02.004

目的

分析影响输尿管镜下逆行球囊扩张术治疗良性输尿管狭窄（US）预后的相关因素。

方法

回顾性分析我科2012年10月至2016年10月期间行输尿管镜逆行球囊扩张术治疗的单侧单发的良性输尿管狭窄患者临床资料，总共40例患者，其中男、女各20例，年龄25～76岁，输尿管狭窄段位置位于盂管交界处12例，输尿管上段8例，中段3例，下段17例。输尿管狭窄段的长度0.2～2 cm。均应用U30球囊扩张器扩张，所有患者术后常规留置双J管或者海马管6个月至1年，每3个月更换一次，术后随访1年。

结果

手术时间45～90 min，平均60 min。术后2～3 d出院，平均住院日2.5 d，无严重并发症，血尿及尿路刺激征并发症发生率较高，术后随访1年，有效患者25例（62.5%），无效患者15例（37.5%）。单因素χ²检验及多因素Logistic回归分析显示输尿管狭窄段的长度及术前患侧肾积水程度是影响输尿管镜球囊扩张术预后的主要因素（P<0.05），而患者的性别、年龄及输尿管狭窄的位置以及狭窄的原因对手术治疗预后无显著影响（P>0.05）。

结论

输尿管镜下逆行球囊扩张术是治疗良性输尿管狭窄安全、有效的手术方法。

关键词: 输尿管狭窄, 球囊扩张, 多因素回归分析

Objective

To analyze the factors influencing the prognosis of benign ureteral stricture which treated by retrograde balloon dilatation in ureteroscopy.

Methods

Forty patients with benign unilateral ureteral stricture who underwent retrograde ureteral balloon dilatation from October 2012 to October 2016 in our department were retrospectively reviewed. Age ranged from 25 to 76 years old. Twelve cases whose ureter stenosis located at the junction of the renal pelvis, 8 cases at the upper ureter, 3 cases at the middle and 17 cases at the lower part. The length of the ureteral stricture was between 0.2 cm and 2 cm. All patients were treated with U30 ureteroscopic balloon dilation catheter, and double J stent or hippocampus ureteral stent was implanted for 6 months to 1 year after operation. The stent was replaced every 3 months and all patients were followed up for one year postoperatively.

Result

The operation time was between 45-90 min, with an average of 60 min. Patients spent an average of 2.5 days in the hospital after operation. There was no severe complication occurred, and the most common type of complications were hematuria and urinary tract irritation. During one year postoperative follow up, 25 patients (62.5%) were successfully treated with ureteral stricture and 15 cases (37.5%) of treatment failure were observed. Univariate Chi-square test and multivariate logistic regression analysis showed that length of ureteral stricture and degree of hydronephrosis were the main factors affecting the prognosis of surgery (P<0.05), whereas gender, age, location of ureteral stricture and causes of the stenosis had no statistical significance (P>0.05).

Conclusion

Ureteroscopic balloon dilatation isa safe and effective surgical treatment for benign ureteral stricture.

Key words: Ureteral stenosis, Balloon dilation, Multivariate Logistic regression analysis

图2 输尿管狭窄患者术前影像学检查评估

图3 输尿管狭窄患者球囊扩张前扩张时、扩张后

表1 输尿管镜下逆行球囊扩张术治疗输尿管狭窄影响预后单因素分析（例）

效果	性别		年龄（岁）			狭窄段长度（cm）			狭窄段位置				肾积水程度
效果	男	女	<40	40~60	>60	<0.5	0.5-1	>1	盂管交界	上段	中段	下段	≤4 cm	>4 cm
有效	13	12	6	13	6	14	8	3	7	6	1	11	17	8
无效	7	8	2	7	6	1	6	8	5	2	2	6	2	13
χ²值	0.107		1.387		12.080				1.746				11.235
P值	0.744		0.500		0.002				0.627				0.001

表1 输尿管镜下逆行球囊扩张术治疗输尿管狭窄影响预后单因素分析（例）

效果	性别		年龄（岁）			狭窄段长度（cm）			狭窄段位置				肾积水程度
效果	男	女	<40	40~60	>60	<0.5	0.5-1	>1	盂管交界	上段	中段	下段	≤4 cm	>4 cm
有效	13	12	6	13	6	14	8	3	7	6	1	11	17	8
无效	7	8	2	7	6	1	6	8	5	2	2	6	2	13
χ²值	0.107		1.387		12.080				1.746				11.235
P值	0.744		0.500		0.002				0.627				0.001

表2 影响预后多因素Logistic回归分析

因素	β	Wald	P值	OR值	95%CI
狭窄段长度	-2.025	7.125	<0.05	0.132	0.030,0.584
肾积水程度	-3.021	7.109	<0.05	0.049	0.005,0.449

表2 影响预后多因素Logistic回归分析

因素	β	Wald	P值	OR值	95%CI
狭窄段长度	-2.025	7.125	<0.05	0.132	0.030,0.584
肾积水程度	-3.021	7.109	<0.05	0.049	0.005,0.449

[1]	Tyritzis SI,Wiklund NP. Ureteral strictures revisited trying to see the light at the end of the tunnel: a comprehensive review[J].J Endourol, 2015, 29(2): 124-136.
[2]	Karadag MA,Tefekli A,Altunrende F, et al. Is routine radiological surveillance mandatory after uncomplicated ureteroscopic stone removal?[J]. J Endourol, 2008, 22(2): 261-266.
[3]	Ambani SN,Faerber GJ,Roberts WW, et al. Ureteral stents for impassable ureteroscopy[J]. J Endourol, 2013, 27(5): 549-553.
[4]	Preminger GM,Tiselius HG,Assimos DG, et al. 2007 guideline for the management of ureteral calculi[J]. J Urol, 2007, 178(6): 2418-2434.
[5]	Bader MJ,Eisner B,Porpiglia F, et al. Contemporary management of ureteral stones[J]. European urology, 2012, 61(4): 764-772.
[6]	张正龙,张继来,陈明等.球囊扩张与开放手术治疗输尿管狭窄的疗效比较[J]. 湖北医药学院学报，2012，31(4): 330-332.
[7]	Tran H,Arsovska O,Paterson RF, et al. Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution[J]. Can Urol Assoc J, 2015, 9(11-12): E921-4.
[8]	刘永达,袁坚,李逊，等. 腔内泌尿外科技术治疗输尿管狭窄[J].中华泌尿外科杂志，2006，27(9): 608-611
[9]	Ravery V,de la Taille A,Hoffmann P, et al. Balloon catheter dilatation in the treatment of ureteral and ureteroenteric stricture[J]. J Endourol, 1998, 12(4): 335-340.
[10]	Markić D,Valencić M,Maricić A, et al. Retrograde balloon dilatation as a minimally invasive treatment for ureteral stricture[J]. Lijec Vjesn, 2012, 134(9-10): 281-285.
[11]	WL Yam,SKT Lim,JK Teo, et al. 130 Balloon dilatation of ureteric and ureteroileal strictures[J]. Eur Urol Suppl, 2016, 15(3), e130.
[12]	Kuntz NJ,Neisius A,Tsivian M, et al. Balloon dilation of the ureter: a contemporary review of outcomes and complications[J]. J Urol, 2015, 194(2): 413-417.
[13]	Punekar SV,Rao SR,Swami G, et al. Balloon dilatation of ureteric strictures[J]. J Postgrad Med, 2000, 46(1): 23-25.
[14]	Osther PJ,Geertsen U,Nielsen HV. Ureteropelvic junction obstruction and ureteral strictures treated by simple high-pressure balloon dilation[J]. J Endourol, 1998, 12(5): 429-431.
[15]	Ning Xu,Shao-Hao Chen,Xue-Yi Xue, et al. Comparison of retrograde balloon dilatation and laparoscopic pyeloplasty for treatment of ureteropelvic junction obstruction: results of a 2-year follow-up[J]. PLoS One, 2016, 11(3): e0152463.
[16]	Byun SS,Kim JH,Oh SJ, et al. Simple retrograde balloon dilation for treatment of ureteral strictures: etiology-based analysis[J]. Yonsei Med J, 2003, 44(2): 273-278.
[17]	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.
[18]	陈志,唐正严,丁见，等. 逆行或顺行球囊扩张术治疗输尿管狭窄[J]. 中国内镜杂志，2014，20(4): 385-387
[19]	Li J,Chen L,Li J, et al. Efficacy and safety of percutaneous renal access flexible ureteroscope plus balloon dilatation for patients with complex lower ureterostenosis[J]. Zhonghua Yi Xue Za Zhi, 2014, 94(46): 3642-3645.
[20]	Zeljko M,Markovic B,Mladenovic A, et al. Balloon dilatation and insertion of temporary coated stents using a retrograde approach in patients with irreversible strictures of the distal ureter[J]. Jpn J Radiol, 2010, 28(9): 695-699.
[21]	Koukouras D,Petsas T,Liatsikos E, et al. Percutaneous minimally invasive management of iatrogenic ureteral injuries[J]. J Endourol, 2010, 24(12): 1921-1927.
[22]	何永忠,李逊,杨炜青，等. 电刀内切开联合球囊扩张治疗输尿管狭窄[J/CD]. 中华腔镜泌尿外科杂志(电子版)，2017，11(2): 113-117.
[23]	陈宁,余祖辉,李辉华，等. 经尿道腔镜下气囊扩张治疗输尿管狭窄[J]. 中华泌尿外科杂志，2003，24(12): 818-820.
[24]	吴元翼,叶林阳,杨渝，等. 球囊扩张治疗输尿管狭窄172例临床观察[J]. 中国现代医药杂志，2009，11(3): 31-33.
[25]	刘若旦,张浩,罗云，等．24 F球囊扩张治疗输尿管狭窄的疗效及安全性评价[J/CD]. 中华腔镜泌尿外科杂志(电子版)，2017，11(4): 241-244.
[26]	路继儒,郑汝强,张峰彬. 双J导管置管时间对输尿管功能的影响[J]. 中华泌尿外科杂志，2000，21(4): 103.
[27]	Brotherhood H,Lange D,Chew BH. Advances in ureteral stents[J]. Transl Androl Urol, 2014, 3(3): 314-319.
[28]	Joshi HB,Stainthorpe A,MacDonagh RP, et al. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility[J]. J Urol, 2003, 169(3): 1065-1069.
[29]	Zhou L,Cai X,Li H. Effects of α-Blockers, Antimuscarinics, or Combination Therapy in Relieving Ureteral Stent-Related Symptoms: A Meta-Analysis[J]. J Endourol, 2015, 29(6): 650-656.

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Clinical data analysis of 40 cases of ureteral stricures treated by ureteroscopic retrograde balloon dilation

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Clinical data analysis of 40 cases of ureteral stricures treated by ureteroscopic retrograde balloon dilation