目的:探讨病因,治疗效果,输尿管良性狭窄的预后相关因素。
方法:我们分析了2013年至2021年142例输尿管良性狭窄患者的数据。95例患者接受了腔内治疗,47例患者接受了重建。术前,术中,术后资料进行对比分析。症状改善和影像学检查堵塞缓解确定了治疗成功。
结果:结石相关因素占85.2%。腔内治疗的总体成功率为51.6%,而重建为95.7%(p<0.01)。然而,腔内治疗在术后住院时间方面更好,操作时间,术中失血(p<0.001)。在腔内逻辑组中,狭窄长度≤2cm的患者,轻度至中度肾积水,近端或远端狭窄的成功率较高.多因素回归分析显示,手术方式是影响手术成功和复发的唯一独立危险因素。重建成功率高于腔内治疗(p=0.001,OR0.057,95%CI(0.011-0.291)),复发率也较低(p=0.001,HR0.074,95%CI(0.016-0.338))。重建未见明显复发,腔内治疗的中位复发时间为51个月。
结论:结石相关因素是输尿管良性狭窄的重要原因。重建成功率高,复发率低,是治疗的金标准。对于长度≤2cm且轻度至中度肾积水的输尿管近端或远端,也优选采用泌尿外科治疗。治疗后需要进一步密切随访。
To investigate the etiology, therapeutic effect, and prognosis-related factors of benign ureteral strictures.
We analyzed the date of 142 patients with benign ureteral strictures from 2013 to 2021. Ninety-five patients received endourological treatment and 47 patients underwent reconstruction. Preoperative, intraoperative, and postoperative information were compared and analyzed. Symptomatic improvement and radiographic blockage alleviation defined therapeutic success.
Stone-related factors caused 85.2% of cases. The overall success rate of endourological treatment was 51.6% versus 95.7% of reconstruction (p < 0.01). However, endourological treatment was better in terms of postoperative hospital stay time, operation time, and intraoperative blood loss (p < 0.001). In endourological group, patients with stricture length ≤2 cm, mild-to-moderate hydronephrosis, proximal or distal stricture had a higher success rate. Multivariate regression analysis showed that the surgical method was the only independent risk factor affecting success and recurrence. Reconstruction success rate was higher than endourological treatment (p = 0.001, OR 0.057, 95% CI (0.011-0.291)), and recurrence rate was also lower (p = 0.001, HR 0.074, 95% CI (0.016-0.338)). No obvious recurrence was seen in reconstruction, and the median recurrence time in endourological treatment was 51 months.
Stone-related factors are an important cause of benign ureteral strictures. Reconstruction is the gold standard treatment due to its high success rate and low recurrence rate. Endourological therapy is also preferred as the initial treatment in proximal or distal ureter with length ≤2 cm and mild-to-moderate hydronephrosis. Further close follow-up is required after treatment.