Abdelrahim Ahmed F, Abdelmaguid Abulfotouh, Abuzeid Hamdi, Amin Moamen, Mousa El-Sayed, Abdelrahim Fahim
Department of Urology, Al-Azhar University, Cairo, Egypt.
J Endourol. 2008 Feb;22(2):277-80. doi: 10.1089/end.2007.0072.
To analyze some of the factors that may be associated with a higher incidence of complications during management of ureteral stones by rigid ureteroscopy.
We reviewed all ureteroscopic interventions aimed at stone extraction and/or fragmentation in our institution from 2001 through 2005. A total of 442 interventions were eligible for inclusion. Our focus was concentrated on (1) patient characteristics (age, gender, duration of symptoms, history of urinary schistosomiasis, and history of surgery involving the affected ureter), (2) stone characteristics (number, length, width, and level of the ureter affected), (3) the affected reno-ureteral unit (which side was affected, the kidney's ability to excrete contrast medium, and the status of the ureter proximal and distal to the stone), and finally (4) experience level of the surgeon in charge (junior v senior). The occurrence of intraoperative adverse events was considered a dependent variable and was statistically related to each of the above factors as independent variables.
Intraoperative adverse events were encountered in 121 interventions including stone migration in 54, minor mucosal injuries in 24, ureteral perforation in 12, ureteral avulsion in 2, and aborted procedure due to bleeding or edema in 29. Symptomatology present for more than 3 months, a negative history of schistosomiasis, a positive history of ureteral surgery, stones above the ischial spines, stones >5 mm in width, a dilated proximal ureter, kidneys that failed to excrete contrast medium, and involvement of a more junior urologist were factors that were associated with a statistically significantly higher incidence of intraoperative complications.
Rigid ureteroscopic stone manipulation remains a procedure that should be handled cautiously. Existence of any of the above risk factors should alert urologists, particularly at training centers, to adopt all possible precautionary measures.
分析在硬性输尿管镜治疗输尿管结石过程中可能与较高并发症发生率相关的一些因素。
我们回顾了2001年至2005年在本院进行的所有旨在取石和/或碎石的输尿管镜干预措施。共有442例干预措施符合纳入标准。我们重点关注以下方面：（1）患者特征（年龄、性别、症状持续时间、血吸虫病病史以及患侧输尿管手术史）；（2）结石特征（数量、长度、宽度以及输尿管受累部位）；（3）患侧肾输尿管单位（哪一侧受累、肾脏排泄造影剂的能力以及结石近端和远端输尿管的状况）；最后（4）主刀医生的经验水平（初级与高级）。术中不良事件的发生被视为因变量，并与上述每个因素作为自变量进行统计学关联。
121例干预措施中出现了术中不良事件，包括结石移位54例、轻微黏膜损伤24例、输尿管穿孔12例、输尿管撕脱2例以及因出血或水肿导致手术中止29例。症状持续超过3个月、血吸虫病病史阴性、输尿管手术史阳性、坐骨棘上方结石、宽度大于５mm的结石、近端输尿管扩张、肾脏排泄造影剂失败以及由经验较少的泌尿外科医生参与手术等因素与术中并发症发生率在统计学上显著较高相关。
硬性输尿管镜取石操作仍是一项应谨慎对待的手术。存在上述任何危险因素都应提醒泌尿外科医生，尤其是在培训中心，采取一切可能的预防措施。
