| Purpose:By comparing the retrograde balloon dilatation surgey,laparoscopic surgey,and open surgey in the treatment of iatrogenic stenosis of the upper ureter,this subject,s purpose is to understands the characteristics of different surgical methods,and then provide a valuable reference for clinical treatment.Method:We had a retrospective analysis in the Department of Urology,Second Hospital of Jilin University from September 2019 to October2021,in the subject we selected the patients who had iatrogenic ureteral stricture with in the upper ureter.Elective criteria were single stenosis,stenosis length was less than 2 cm,hydronephrosis was mild to moderate and stenosis occured within 3 months.With reference to the inclusion and exclusion criteria,a total of 66 patients were identified in the study,and all patients signed the informed consent forms.The patients were divided into three groups according to different surgical methods,the first group was performed with retrograde balloon dilation surgery with a total of 21 cases,and the second group including 18 patients was treated with laparoscopic ureteroureterostomy.There were 27 cases in the last group which was treated with open ureteroureterostomy.Among three groups,the patients were compared in the aspects including the operation time,intraoperative blood loss,postoperative hospital stay and hospitalization cost,and postoperative complications（pain,fever,hematuria,incision infection,anastomotic leakage,lower extremity thrombosis,lower urinary tract irritation,etc）.According to the indicators and related imaging tests of the follow-up patients in March,June and One year after the removal of the double J tube.Finally,using IBM SPSS 25.0 statistical software in order to collect and analyze all the data,and the measurement data in the paper was represented by mean standard deviation,and univariate ANOVA were used when multi-group data were compared if the normal distribution was met and the variance was aligned,kruskal-Wallis test was used if the normal distribution was not met or the analysis of variance was not met;the difference comparison was made by chi-square test when comparing counting data between multiple groups,and the fisher exact probability method was used for comparison when the theoretical frequency was small,and p < 0.05 was statistically significant.Result:The surgeries were successfully completed for all 66 patients.There was no noticeable difference in age,gender,length of stenosis,location of stenosis and body weight among the three groups when counting clinical data（p > 0.05）.In terms of operation time: the balloon dilatation group was 43.29 ±13.37 min,the laparoscopic group was 153.56 ± 26.01 min,and the open surgey group was 115.33 ± 25.57 min,the balloon dilation group was significantly shorter than the laparoscopic group（p < 0.001）and the open group（p < 0.001）,while the laparoscopic group was longer than the open group（p < 0.001）;in terms of intraoperative blood loss: the balloon dilation group was 15.33 ± 4.95 ml,the laparoscopic group was 66.94 ±16.74 ml,and the open group was 114.92 ± 27.20 ml,the balloon dilation group was significantly less than the laparoscopic group（p < 0.001）and the open group（p < 0.001）,and the laparoscopic group was less than the open group（p < 0.001）;in terms of postoperative hospital stay: balloon dilation was 3.00 ± 1.14 d,the laparoscopic group was 6.83 ± 1.20 d,and the open group was 10.48 ± 2.79 d,the balloon dilation group was less than the laparoscopic group（p < 0.001）and the open group（p < 0.001）,and the laparoscopic group was less than the open group（p < 0.001）;in terms of hospitalization expenses: the balloon dilation group was 18.3 ±4.9 thousand yuan,the laparoscopic group was 36 ± 8.4 thousand yuan,and the open group was 30.1 ± 7.1 thousand yuan,the balloon dilation group was less than the laparoscopic group（p < 0.001）and the open group（p < 0.001）,and the laparoscopic group was more than the open group（p < 0.01）.In the comparison of short-term complications after surgery: fever（p = 0.531）,pain（p = 0.531）,hematuria（p = 0.846）,symptoms of lower urinary tract irritation（p = 0.347）,leakage of urine from the anastomotic mouth（p = 0.075）,incisional infection（p = 0.146）,lower extremity thrombosis（p = 0.480）,and others（p = 0.580）were not statistically significant.There was no statistically significant efficiency of follow-up of patients with different groups of surgical procedures at 3months（p = 0.591）and June（p = 0.538）after removal of double J tubes,while there was a significant difference in efficiency（p = 0.035）in 1 year after removal of double J tubes,and it was obtained by repeated two-two comparison: the efficiency difference between the laparoscopic group and the open group after removal of the double J tube was not significant and not statistically significant（p = 0.575）,while the efficiency difference between the balloon dilation group and the laparoscopic group was significant in the efficiency of double J tube removal for 1 year.There was a statistically significant difference（p = 0.042）,and the efficiency difference between the balloon dilation group and the open group in the1-year efficiency of removing the double J tube was significant and statistically significant（p = 0.011）.Conclusion:1.Retrograde balloon dilation,laparoscopy and open surgery are safe and effective in the treatment of iatrogenic ureteral stricture with in the upper ureter.2.For patients whose ureteral stenosis was single stenosis,stenosis length was less than 2 cm,hydronephrosis was mild to moderate and stenosis occured within 3 months,balloon dilation has obvious advantages than laparoscopic surgery and open surgery in the operation time 、 intraoperative blood loss 、 postoperative hospital stay and hospitalization expenses,and the short-term efficacy is not significantly different from the other two groups,but the long-term efficacy is poor,and many patients undergo secondary surgery.3.There was no significant difference between the laparoscopic group and the open group in terms of short-term and long-term efficacy,but the laparoscopic group had longer operation time,less intraoperative blood loss and faster postoperative recovery than the open group.4.Patients with ureteral stricture need individualized treatment,including preoperative comprehensive evaluation of the patient’s physical status,economy,history of previous,stenosis nature,stenosis site,stenosis length and other factors. |
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