| Objective:To compare the clinical effects of three kinds of endoscopic treatment in the treatment of ureteral stricture(US),and further explore the related factors affecting the efficacy.Methods:The clinical data of 79 patients with ureteral stricture admitted to the Affiliated Hospital of Zunyi Medical University from April 2016 to July 2019 were collected for retrospective analysis.They were divided into three groups for comparative study,There were 13 cases in Combination therapy(CT)group,27 cases in Balloon dilatation(BD)group and 39 cases in Holmium laser(HL)group.The operative approach,operative time,hospitalization time,retention time of double J tube,number of double J tube,operative complications and postoperative efficiency were compared among the three groups.The relationship between postoperative efficiency and stenosis length,stenosis site,degree of hydronephrosis on the affected side,retention time of double J tube and number of double J tube was analyzed.After 1,3,6 months follow-up,the patients were divided into three groups.Single factor Logistic regression analysis was used to analyze the relationship between age,urinary leukocyte,gender,urine culture,length of stricture,creatinine,stricture site,degree of hydronephrosis on the affected side,operation approach,operation time,number of ureteral stent,time of ureteral stent,etc.and the effect(?~2test,P<0.05)The variables with statistical significance were further analyzed by multivariate logistic regression analysis.Results:1.The operation time of CT group,BD group and HL group were 119.46±53.03min,54.15±21.12min and 63.36±39.62min,respectively;the postoperative hospital stay of CT group,BD group and HL group were 12.31±4.89d,5.00±2.68d and 6.46±3.00d,respectively;the retention time of double J tube was 539.62±303.70d,133.63±72.71d and 204.23±171.43d.The operation time,hospitalization time and double J tube indwelling time in CT group were significantly longer than those in BD group and HL group(P<0.001),but there was no significant difference in operation time,hospitalization time and double J tube indwelling time between BD group and HL group(P>0.05).2.Comparison of the complications of the three groups:The complications of the three groups were compared:one case of perirenal hematoma,two cases of intrarenal hemorrhage,one case of urinary sepsis in CT group,and no complications in BD group.In HL group,there was a case of urinary sepsis.There was significant difference between the three groups(P<0.05).The incidence of complications in CT group was significantly higher than that in BD group and HL group(P<0.0167),but there was no significant difference between BD group and HL group(P>0.0167).3.There was no significant difference in the effective rate of the three kinds of operation in the first month,the third month and the sixth month after removing the double J tube(P>0.05).In the single factor statistical analysis,the length of stenosis and the degree of hydronephrosis in the affected side were related to the operative effect(P<0.05);age,urinary leukocyte,gender,urine culture,creatinine,stenosis site,operative approach,operative time,number of indwelling urinary stent,indwelling ureter stent time were not related to the operative effect(P>0.05).Multivariate logistic regression analysis showed that the degree of hydronephrosis and the length of stenosis were the factors influencing the therapeutic effect.Conclusion:1.There was no difference in short-term effect among the three kinds of minimally invasive surgery.According to the principle from simple to complex,balloon dilatation is the first choice,followed by holmium laser internal incision.If the curative effect of holmium laser internal incision is not satisfied,combined treatment can be used.2.The degree of hydronephrosis in the affected side and the length of stenosis may be the independent influencing factors of the curative effect after minimally invasive surgery. |
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