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围手术期输尿管导管放置的并发症:一家大型癌症中心的经验。

Complications Of Peri-Operative Ureteral Catheter Placement: Experience at A Major Cancer Center.

机构信息

University of Texas Medical School at Houston, Houston, TX; University of Texas MD Anderson Cancer Center, Houston, TX.

University of Texas MD Anderson Cancer Center, Houston, TX.

出版信息

Urology. 2022 Jun;164:88-93. doi: 10.1016/j.urology.2021.04.068. Epub 2021 Jul 16.

DOI:10.1016/j.urology.2021.04.068
PMID:34280440
Abstract

OBJECTIVE

To evaluate risks of peri-operative ureteral catheter placement in a consecutive patient-series.

METHODS

Patients who underwent peri-operative ureteral catheter placement at a single institution in 2018 were included. A retrospective review was conducted to evaluate patient and procedure related characteristics, including data on technique, perceived placement difficulty, operative details, and complications.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Urologic complications within 30 days were evaluated using the Clavien-Dindo system. Statistical analysis for association was conducted using the X2 test or fisher's exact tests.

RESULTS

413 patients were included. 50/413 (12.1%) cases had urologic complications within 30 days. 43 were Clavien-Dindo grade I-II. Six were grade III. 5/6 patients had oliguric, obstructive AKI. One had flank pain with hydronephrosis. Two patients each underwent placement of unilateral nephrostomy tube, bilateral double-J stent placement, and unilateral stent placement. One patient had a Grade V complication. They developed multi-system organ failure including renal failure with hydronephrosis.All patients who required re-intervention had bilateral peri-operative catheterization with use of a wire. Intraoperative difficulty with placement was associated with high-grade complication (P<.01)). Limitations include retrospective,single center study design.

CONCLUSIONS

Rate of acute complication following ureteral catheter placement is 12%. 1.7% of patients develop post-operative ureteral obstruction requiring intervention within 30 days. Future studies are needed to determine patients most at risk for post-ureteral stent complication.

摘要

目的

评估连续患者系列中围手术期输尿管导管放置的风险。

方法

纳入 2018 年在一家机构接受围手术期输尿管导管放置的患者。进行回顾性研究,以评估患者和手术相关特征,包括技术、感知放置难度、手术细节和并发症的数据。

结果

413 例患者入选。413 例患者中有 50 例(12.1%)在 30 天内发生泌尿系统并发症。43 例为 Clavien-Dindo 分级 I-II 级。6 例为 III 级。5/6 例患者为少尿性、梗阻性 AKI。1 例出现腰痛伴肾积水。2 例患者分别接受单侧肾造瘘管、双侧双 J 支架置入和单侧支架置入。1 例患者发生 5 级并发症。他们发生了多系统器官衰竭,包括伴有肾积水的肾功能衰竭。所有需要再次干预的患者均采用导丝进行双侧围手术期导管插入术。术中放置困难与高等级并发症相关(P<.01)。局限性包括回顾性、单中心研究设计。

结论

输尿管导管放置后急性并发症的发生率为 12%。1.7%的患者在 30 天内发生术后输尿管梗阻,需要干预。需要进一步研究以确定最易发生输尿管支架并发症的患者。

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