Al-Marhoon Mohammed S, Shareef Omar, Venkiteswaran Krishna P
Urology Division, Department of Surgery, Sultan Qaboos University Hospital, Oman.
Arab J Urol. 2012 Dec;10(4):372-7. doi: 10.1016/j.aju.2012.08.004. Epub 2012 Oct 11.
To determine the factors affecting the development of complications and the outcomes of JJ stenting.
The study included 220 patients (133 males and 87 females, mean age 39.5 years, SD 15.4) who had self-retaining JJ ureteric stents placed while in the authors' institution. Univariate and multivariate analyses were used to identify the significant variables affecting the development of complications and outcome of stenting (condition 'improved' or 'not improved').
Using a modified Clavien classification, there were grade I, II, IIIa, IIIb complications in 67 (30.4%), 39 (17.7%), two (0.9%) and 23 (10.5%) patients, respectively, and none of grades IVa, IVb and V. Loin pain (10.9%) and urinary tract infection (10.9%) were the most common complications, followed by dysuria (7.7%). There were significant complications requiring treatment in 29% of patients, and 71.4% of patients improved after stenting. On multivariate analysis the significant independent factor affecting the complication rate was the stent length (P = 0.016), and the significant independent factor affecting the 'improved' outcome was age (P = 0.014).
Longer stents are associated with increased complication rates, and the older the patient the more likely they are to have a poor outcome after stenting. Future prospective multicentre studies with more patients are needed to confirm the present conclusions.
确定影响并发症发生及双J管支架置入术结局的因素。
本研究纳入了220例患者(男性133例,女性87例,平均年龄39.5岁,标准差15.4),这些患者均在作者所在机构置入了自固定双J输尿管支架。采用单因素和多因素分析来确定影响并发症发生及支架置入术结局(病情“改善”或“未改善”)的显著变量。
采用改良的Clavien分类法,分别有67例(30.4%)、39例(17.7%)、2例(0.9%)和23例(10.5%)患者发生Ⅰ级、Ⅱ级、Ⅲa级、Ⅲb级并发症,无Ⅳa级、Ⅳb级和Ⅴ级并发症发生。腰痛(10.9%)和尿路感染(10.9%)是最常见的并发症,其次是排尿困难(7.7%)。29%的患者发生了需要治疗的严重并发症,71.4%的患者在支架置入术后病情改善。多因素分析显示,影响并发症发生率的显著独立因素是支架长度(P = 0.016),影响“改善”结局的显著独立因素是年龄(P = 0.014)。
较长的支架与较高的并发症发生率相关,患者年龄越大,支架置入术后预后不良的可能性越大。未来需要开展纳入更多患者的前瞻性多中心研究来证实本研究结论。