良性输尿管狭窄球囊扩张术疗效及失败危险因素分析

Analysis of the Efficacy and Risk Factors for Failure of Balloon Dilation for Benign Ureteral Stricture.

作者信息

Wang Bing, Gao Wenzhi, Yang Kunlin, Liu Honglei, Han Yangjun, Diao Mingxin, Zuo Chao, Zhang Minghua, Diao Yingzhi, Li Zhihua, Li Xinfei, Wang Gang, Zhang Peng, Wang Chunji, Xiao Chunjuan, Huang Chen, Gu Yaming, Li Xuesong

机构信息

Department of Urology, Peking University First Hospital-Miyun Hospital, Beijing 100034, China.

Department of Urology, The Third Hospital of Hebei Medical University, Shijiazhuang 050011, China.

出版信息

J Clin Med. 2023 Feb 19;12(4):1655. doi: 10.3390/jcm12041655.

DOI:10.3390/jcm12041655

PMID:36836191

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9963490/

Abstract

This study aimed to investigate the efficacy of balloon dilation in ureteral stricture and to analyze the risk factors for the failure of balloon dilation, which will hopefully provide some reference for clinicians to develop treatment plans. We retrospectively analyzed 196 patients who underwent balloon dilation between January 2012 and August 2022, 127 of whom had complete baseline and follow-up data. General clinical data, perioperative data, balloon parameters at the time of surgery, and follow-up results were collected from the patients. Univariate and multivariate logistic regression analyses were performed for the risk factors for surgical failure in patients undergoing balloon dilatation. The success rates of balloon dilatation ( = 30) and balloon dilatation combined with endoureterotomy ( = 37) for lower ureteral stricture at 3 months, 6 months, and 1 year were 81.08%, 78.38%, and 78.38% and 90%, 90%, and 86.67%, respectively. The success rates of balloon dilation at 3 months, 6 months, and 1 year in patients with recurrent upper ureteral stricture after pyeloplasty ( = 15) and primary treatment ( = 30) were 73.33%, 60%, and 53.33% and 80%, 80%, and 73.33%, respectively. The success rates of surgery at 3 months, 6 months, and 1 year for patients with recurrence of lower ureteral stricture after ureteral reimplantation or endoureterotomy ( = 4) and primary treatment with balloon dilatation ( = 34) were 75%, 75%, and 75% and 85.29%, 79.41%, and 79.41%, respectively. Multivariate analysis of the failure of balloon dilation showed that balloon circumference and multiple ureteral strictures were risk factors for balloon dilation failure (OR = 0.143, 95% CI: 0.023-0.895, = 0.038; OR = 1.221, 95% CI: 1.002-1.491, = 0.05). Balloon dilation combined with endoureterotomy in lower ureteral stricture had a higher success rate than balloon dilation alone. The success rate of balloon dilation in the primary treatment of the upper and lower ureter was higher than that of balloon dilation in the secondary treatment after failed repair surgery. Balloon circumference and multiple ureteral strictures are risk factors for balloon dilation failure.

摘要

本研究旨在探讨球囊扩张术治疗输尿管狭窄的疗效，并分析球囊扩张术失败的危险因素，以期为临床医生制定治疗方案提供参考。我们回顾性分析了2012年1月至2022年8月期间接受球囊扩张术的196例患者，其中127例有完整的基线和随访数据。收集患者的一般临床资料、围手术期资料、手术时的球囊参数及随访结果。对接受球囊扩张术患者手术失败的危险因素进行单因素和多因素logistic回归分析。输尿管下段狭窄行球囊扩张术（n = 30）和球囊扩张联合输尿管内切开术（n = 37）在3个月、6个月和1年时的成功率分别为81.08%、78.38%、78.38%和90%、90%、86.67%。肾盂成形术后复发性输尿管上段狭窄患者（n = 15）和初次治疗患者（n = 30）行球囊扩张术在3个月、6个月和1年时的成功率分别为73.33%、60%、53.33%和80%、80%、73.33%。输尿管再植术或输尿管内切开术后输尿管下段狭窄复发患者（n = 4）和初次行球囊扩张术治疗患者（n = 34）在3个月、6个月和1年时的手术成功率分别为75%、75%、75%和85.29%、79.41%、79.41%。球囊扩张术失败的多因素分析显示，球囊周长和多处输尿管狭窄是球囊扩张术失败的危险因素（OR = 0.143，95%CI：0.023 - 0.895，P = 0.038；OR = 1.221，95%CI：1.002 - 1.491，P = 0.05）。输尿管下段狭窄行球囊扩张联合输尿管内切开术的成功率高于单纯球囊扩张术。输尿管上段和下段初次治疗时球囊扩张术的成功率高于修复手术失败后二次治疗时球囊扩张术的成功率。球囊周长和多处输尿管狭窄是球囊扩张术失败的危险因素。