Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Investig Clin Urol. 2018 Nov;59(6):376-382. doi: 10.4111/icu.2018.59.6.376. Epub 2018 Oct 26.
The authors performed this study to investigate the risk factors for predicting stent failure and to evaluate its impact on prognosis.
Between January 2002 and March 2017, we retrospectively reviewed 117 consecutive patients who underwent retrograde ureteral stenting and exchanging at least once every 3 months for malignant ureteral obstruction. The patients were classified according to their pre-stenting chronic kidney disease (CKD) stage. The factors affecting stent failure were analyzed using a logistic regression model. Overall survival (OS) was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling.
Before stenting, 91 patients were CKD stages 1-3 and 26 patients were CKD stages 4-5. These two groups differed significantly only in pre-stenting estimated glomerular filtration rate (eGFR), bilateral obstruction, and pre-stenting pyuria. Among the 117 patients, stent failure occurred in 30 patients (25.6%), and there were no differences between the groups. Pre-stenting pyuria and post-stenting complications were significant predictors of stent failure. There were 79 deaths in total, including 56 in the CKD stages 1-3 group and 23 in the CKD stages 4-5 group. In the multivariate analysis predicting patient OS, pre-stenting eGFR and post-stenting disease progression were significant factors.
Internal ureteral stenting was effective for maintaining renal function in malignant ureteral obstruction. However, it did not restore renal function, which is related to the prognosis of the patients. Therefore, to improve patients' renal function and prognosis, patients who require stenting must be quickly recognized and treated.
作者进行这项研究旨在探讨预测支架失败的危险因素,并评估其对预后的影响。
回顾性分析 2002 年 1 月至 2017 年 3 月期间 117 例因恶性输尿管梗阻而行逆行输尿管支架置入术并至少每 3 个月更换一次的连续患者。根据患者置管前的慢性肾脏病(CKD)分期对患者进行分类。使用逻辑回归模型分析影响支架失败的因素。采用 Cox 比例风险回归模型估计总生存期(OS),并估计各变量的预后意义。
置管前,91 例患者为 CKD 1-3 期,26 例患者为 CKD 4-5 期。这两组仅在置管前估计肾小球滤过率(eGFR)、双侧梗阻和置管前脓尿方面存在显著差异。在 117 例患者中,30 例(25.6%)发生支架失败,两组之间无差异。置管前脓尿和置管后并发症是支架失败的显著预测因素。共有 79 例死亡,其中 CKD 1-3 期组 56 例,CKD 4-5 期组 23 例。在预测患者 OS 的多变量分析中,置管前 eGFR 和置管后疾病进展是显著因素。
内输尿管支架置入术对维持恶性输尿管梗阻患者的肾功能有效。然而,它并没有恢复肾功能,这与患者的预后有关。因此,为了改善患者的肾功能和预后,必须尽快识别和治疗需要支架置入的患者。