输尿管支架置入术后支架相关并发症状况调查及其影响因素分析-现代医学

输尿管支架置入术后支架相关并发症状况调查及其影响因素分析

单位：1. 南京医科大学第四附属医院泌尿外科, 江苏南京 210029;
2. 南京医科大学第二附属医院泌尿外科, 江苏南京 210011

分类号：R691.4

出版年·卷·期（页码）：2023·51·第十期（1359-1364）

摘要：

目的：了解泌尿系结石术后留置输尿管支架引发的相关并发症现状并分析其危险因素。方法：选取2019年12月1日至2022年5月31日，于南京市城北及江北地区综合性医院就诊的376例留置输尿管支架的患者为研究对象，患者拔管时行问卷调查，包括膀胱过度活动症评分表（OABSS）、生活质量指数（QOL）评分表、输尿管支架相关症状问卷（USSQ）。收集临床资料，并对疾病特征给予相关分析。结果：376例研究对象中，男257例（68.35%），女119例（31.65%），平均年龄（42.18±9.29）岁，平均置管时间（22.19±7.10） d。OABSS提示，发生膀胱过度活动症（OAB）有202例（53.72%），分别为轻度OAB 105例（27.93%）、中度OAB 93例（24.73%）、重度OAB 4例（1.06%）。输尿管支架相关并发症中夜尿占比为81.38%，其余依次为血尿（77.66%）、躯体疼痛（70.74%）、尿不尽（66.49%）、尿频（63.83%）、尿痛（61.70%）、尿急（51.60%），13.30%的患者出现尿失禁。48％的患者感觉生活质量下降。单因素分析结果显示，体质量指数（BMI）、输尿管支架型号、每日饮水量、留置时间和输尿管支架远端是否越过耻骨联合中线是下尿路症状的危险因素；输尿管支架型号、支架管近端是否位于肾盂是发生疼痛的危险因素。性别、术前是否尿路感染与USSQ中一般健康状况评分相关。多因素Logistic回归分析结果提示，性别、BMI、输尿管支架型号、每日饮水量、留置时间、支架管近端是否位于肾盂和输尿管支架远端是否越过耻骨联合中线，是影响留置输尿管支架患者输尿管支架相关并发症的危险因素。结论：输尿管支架引起的泌尿系症状和疼痛严重影响患者日常生活，继发性OAB是引起患者生活质量下降的主要原因，针对性地选用合适型号及长度的输尿管支架，保证术中置管到位，充分的健康宣教均有助于改善患者生活质量。

Objective: To investigate on prevalence of ureteral stent complications and its influencing factors in individuals with indwelling ureteral stents following urolithotomy. Methods: 376 patients with indwelling ureteral stent who were hospitalized in the comprehensive hospitals in northern Nanjing and the north of the Yangtze River from December 1st, 2019 to May 31st, 2022 were selected as subjects. The subjects were extubated with questionnaires, including overactive bladder symptom score(OABSS), quality-of-life index(QOL) scale, and ureteral stent symptom questionnaire(USSQ). Furthermore,clinical data were collected and disease characteristics were analyzed. Results: The 376 subjects had an average age of(42.18±9.29) years, with 257(68.35%) males and 119(31.65%) females. The average time of intubation was(22.19±7.10) days. OABSS scores showed 202 cases(53.27%) of overactive bladder(OAB), including 105 cases(27.93%) of mild OAB, 93 cases(24.73%) of moderate OAB, and 4 cases(1.06%) of severe OAB. Among the complications related to ureteral stents in patients with indwelling ureteral stents, nocturia accounted for 81.38%, followed by hematuria(77.66%), body pain(70.74%), incomplete urination(66.49%), frequency of urination(63.83%), pain in urination(61.70%), and urgency of urination(51.60%). Some patients had urinary incontinence(13.30%). What's more, 48% of patients felt that the quality of life was decreased. The results of univariate analysis showed that body mass index(BMI), stent diameter, daily water consumption, indwelling time and whether the distal stent crossed the midline of the pubic symphysis were risk factors for lower urinary tract symptoms; The diameter of ureteral stent and the presence or absence of the proximal end of the stent tube in the renal pelvis were risk factors for pain. Gender, preoperative urinary tract infection were related to the general health status score in USSQ. It was further found by multiple linear regression analysis that gender, BMI, diameter of stent, daily water consumption, indwelling time, whether the proximal end of the stent located in the renal pelvis and whether the distal end of stent crosses the midline of pubic symphysis were risk factors for ureteral stent complications in patients with indwelling ureteral stent. Conclusion: Urinary symptoms and pain caused by ureteral stents seriously affect patients' quality of daily life. In addition, secondary OAB is the main cause of reduced guality of life. Targeted selection of appropriate type and length of ureteral stents, ensuring that intraoperative placement of tubes are in place, and adequate health education can help to improve patients' quality of life.

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