Roberts W W, Cadeddu J A, Micali S, Kavoussi L R, Moore R G
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Urol. 1998 Mar;159(3):723-6.
We retrospectively evaluated the records of 21 patients a mean of 46.1 years old with ureteral stones that had been impacted for greater than 2 months to determine predisposing factors for stricture formation.
Between January 1993 and September 1996, 21 patients were referred for ureteral stones that had remained unchanged in location for at least 2 months. In 11 patients previous attempts at stone removal had failed. Each patient underwent successful stone extraction by retrograde or percutaneous antegrade ureteroscopy, or laparoscopic or open ureterolithotomy. Outcome was determined by reviewing the clinical records and radiographic studies, including excretory urography and nephrostography.
Average duration of stone impaction before definitive treatment was 8.8 months (range 2 to 48) and mean stone size was 10.3 mm. (range 1 to 30). All stones were calcium based. There were 3 proximal, 8 mid and 10 distal ureteral calculi. At a mean followup of 7 months ureteral strictures developed in 5 patients (24%) at the previous stone site. Mean duration of stone impaction was 11 months (range 5 to 17) in patients with stricture versus 8.2 months (range 2 to 48) in those with no stricture. Four of the 5 strictures occurred in patients who had had iatrogenic ureteral perforation during previous unsuccessful attempts at stone removal.
Ureteral stone impaction more than 2 months in duration is associated with a 24% incidence of stricture formation. Ureteral perforation at the site of the stone was identified as the primary risk factor for stricture formation in these cases.
我们回顾性评估了21例平均年龄46.1岁、输尿管结石嵌顿超过2个月的患者记录，以确定狭窄形成的易感因素。
1993年1月至1996年9月期间，21例患者因输尿管结石位置至少2个月未改变而前来就诊。其中11例患者先前的取石尝试失败。每位患者均通过逆行或经皮顺行输尿管镜检查、腹腔镜或开放输尿管切开取石术成功取出结石。通过回顾临床记录和影像学检查结果（包括排泄性尿路造影和肾造瘘造影）来确定治疗结果。
最终治疗前结石嵌顿的平均持续时间为8.8个月（范围2至48个月），平均结石大小为10.3毫米（范围1至30毫米）。所有结石均为钙盐结石。有3例近端、8例中段和10例远端输尿管结石。平均随访7个月时，5例患者（24%）在先前结石部位出现输尿管狭窄。发生狭窄的患者结石嵌顿平均持续时间为11个月（范围5至17个月），而未发生狭窄的患者为8.2个月（范围2至48个月）。5例狭窄中有4例发生在先前取石失败尝试期间发生医源性输尿管穿孔的患者中。
输尿管结石嵌顿持续超过2个月与24%的狭窄形成发生率相关。在这些病例中，结石部位的输尿管穿孔被确定为狭窄形成的主要危险因素。
