| Objective Objective to analyze and evaluate the clinical application value of Allium covered ureteral stent and resonance metal ureteral stent in ureteral obstruction,and to explore the factors influencing the drainage effect of Allium coated ureteral stent.Methods 72 patients with upper urinary tract effusion caused by benign or malignant factors in our hospital from May 2018 to may 2020 were retrospectively analyzed.The same treatment group in our department was treated by retrograde placement of Allium coated ureteral stent or Resonance metal ureteral stent to relieve obstruction.The success rate of catheterization,the patency rate of stent drainage,the duration of stent drainage,the recovery level of postoperative obstructive nephropathy evaluation indexes(creatinine,blood urea nitrogen,uric acid,Cystatin C,urinary white blood cells,urinary red blood cells),the degree of hydronephrosis,the occurrence of stent complications and the stent related complications were evaluated.Cox regression model was used to analyze the influencing factors of drainage duration of Allium coated ureteral stent.Results(1)Allium group,25 patients(32 ureteral units)were included in the final analysis.Four patients died of primary disease(6 ureteral units),and no data of 1 year after operation were included in the analysis.There were 11 males(44%)and 14 females(56%)with an average age of 49.76±10.65 years.There were 13 cases(52%)of digestive tract tumors,9 cases(36%)of gynecological tumors,1 case(4%)of endometriosis,1 case(4%)of urinary calculi and 1 case(4%)of multiple abdominal abscesses.The average indwelling time was 15.4 months,and the longest indwelling time was 24 months.The effective rate of stent was 88.5%,the patency rate at 3 months was 100%,the patency rate at 6 months was 96.2%,and the patency rate at 12 months was 88.5%.There were 32 patients(39 ureteral units)in the Resonance group.There were 13 males(52.6%)and 19 females(47.4%),with an average age of 52.22±10.61 years.There were 18 cases(56.3%)of digestive tract tumors,8 cases(25%)of gynecological tumors,1 case(3.1%)of presacral mucinous carcinoma,1 case(3.1%)of presacral neuroendocrine tumor,1 case(3.1%)of abdominal malignant mesothelioma,1 case(3.1%)of retroperitoneal fibrosis,1 case(3.1%)of Crohn’s disease and 1 case(3.1%)of multiple abdominal abscesses.The average indwelling time was 7.5 months,and the longest indwelling time was 15 months.The effective rate of stenting was 61.5%,the patency rate at 3 months was 94.9%,the patency rate at 6 months was 61.5%,and the patency rate at 12 months was 23.1%.(2)The success rate of catheter placement was 100%in both the Allium group and the Resonance group.In terms of drainage effect,the hydronephrosis and the evaluation indexes of obstructive nephropathy(creatinine,blood urea nitrogen,uric acid,Cystatin C,urine leukocytes)in Allium group within one week and one year after operation were significantly lower than those before operation(P<0.05).The hydronephrosis and evaluation indexes of obstructive nephropathy(creatinine,blood urea nitrogen,uric acid,Cystatin C)in one week and one year after operation in the resonance group were lower than those before operation,and the difference was not statistically significant(P<0.05).The overall complication rate was 15.6%in Allium group and 46.2%in resonance group;In Allium group,the incidence of urinary system related symptoms was 19%,and the incidence of pain was 14.3%;In the resonance group,the incidence of urinary system related symptoms was 56.3%,and the incidence of pain was 75%.In terms of quality of life,Allium stent had little effect on life and work,appetite,spirit and sleep.More than 80%of patients felt the same as before operation;In the resonance group,more than 30%of the patients said that the stent had a certain impact on sleep and spirit.About stent satisfaction,66.7%of patients in Allium group were satisfied with life with stent,and 18.8%of patients in resonance group were satisfied with life with stent.(3)Statistical analysis of the data of patients with Allium stent showed that age,preoperative creatinine and cystatin C were significantly related to the drainage efficiency(P<0.05).Univariate Cox regression model suggested that age was an independent prognostic factor for stent drainage duration(HR 0.885,95%CI 0.789-0.993,P<0.05).Conclusion Allium covered ureteral stent and resonance metal ureteral stent are easy to be implanted in the treatment of ureteral obstruction.Both of them can effectively relieve obstruction and drain fluid.Allium covered ureteral stent has low irritation,low incidence of urinary symptoms and pain,and high patient satisfaction.Resonance metal ureteral stent has a high incidence of pain,which may affect the sleep and spirit of patients.In clinical practice,the stent should be selected reasonably according to the individual conditions of patients.In the clinical characteristics of patients,age,preoperative creatinine and cystatin C were significantly correlated with drainage efficiency(P<0.05).However,age was an independent prognostic factor for stent drainage duration(HR 0.885,95%CI 0.789-0.993,P<0.05).Therefore,in clinical work,for the patients with Allium stent placement,younger age and higher degree of malignancy,we should strengthen the follow-up and review of the urinary system while actively treating the primary disease. |
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