经皮顺行双J支架置入治疗输尿管狭窄

目的：评价经皮顺行双J支架置入治疗输尿管狭窄的安全性和有效性,探讨相关技术要点和注意事项。方法：对126例输尿管狭窄患者（共157侧）在经皮肾造瘘术后行顺行双J输尿管支架置入术,分析手术成功率、并发症和临床效果。结果：157侧输尿管狭窄在经皮肾造瘘术后,一步法顺行置入双J输尿管支架42侧,两步法置入110侧,5侧失败,手术成功率96．8％。同侧置入单根输尿管支架者141侧,2根者7侧,3根者4侧。全部患者引流效果良好,无严重并发症发生。结论：对于逆行插管失败的输尿管狭窄患者,经皮顺行置入双J输尿管支架安全有效,注意技术要点、仔细操作能够减少并发症。     

经皮肾穿刺经尿道双途径球囊扩张并双"J"支架置入治疗输尿管狭窄和梗阻

目的 评价输尿管良、恶性狭窄和梗阻通过经皮肾穿刺经尿道双途径球囊扩张并双“J”支架置入的治疗效果。方法 131例输尿管狭窄或梗阻患者，其中良性125例，恶性6例；采用经皮肾穿刺经尿道双途径球囊扩张并置入双“J”支架联合介入治疗方法，随访6个月至10年。结果 良性输尿管狭窄和梗阻125例，成功123例，失败2例。恶性输尿管狭窄和梗阻6例，均获成功。治愈95例，占72．5％；好转34例，占26．0％；无效2例，占1．5％，总有效率98．5％。结论 经皮肾穿刺经尿道双途径球囊扩张并双“J”支架置入联合介入治疗输尿管狭窄和梗阻，创伤小，并发症少，治疗效果显著。     

介入治疗输尿管狭窄一例

金属内支架置入术治疗良性输尿管狭窄已有报道。2002年9月20日我院成功的将3枚胆道支架及一支双头猪尾巴内涵管共同置入输尿管内以治疗输尿管狭窄、梗阻，取得了满意的疗效。现报道如下。     

恶性输尿管梗阻的综合介入治疗18例

【摘要】 目的 探讨膀胱镜下输尿管支架置入失败或无法置入的恶性输尿管梗阻患者介入治疗策略。方法 收集2016年1月到2019年9月因恶性输尿管梗阻行膀胱镜下输尿管支架置入失败患者18例,共22条梗阻输尿管,先采用经皮穿刺肾盂,常规或改良的微导丝贯通技术建立贯通通道,然后利用交换导管导丝技术,逆行置入输尿管支架,对常规及改良法都无法建立微导丝贯通的患者行经皮肾盂造瘘术。 结果 所有的22条梗阻输尿管均采用介入方法得到了治疗,18例患者22条梗阻输尿管中,常规微导丝贯通术成功18条,4条常规微导丝贯通失败患者,均行改良微导丝贯通术,成功3例,其中2例为膀胱全切术后回肠代膀胱、回肠造瘘患者,均成功放置输尿管支架,1例改良微导丝贯通术通过输尿管重度狭窄段并成功逆行置入输尿管支架,1例改良微导丝贯通失败患者改行经皮肾盂造瘘术。所有微导丝贯通成功患者术后均未见肉眼血尿;术后第7天所有患者肾盂输尿管扩张较术前明显好转,术后第7天患者肌酐水平（88.89±22.19） μmol/L,较术前（233.44±125.63） μmol/L有明显下降,差异有显著统计学意义（T=5.329 P＜0.001）。结论 对于膀胱镜下输尿管支架置入失败的恶性输尿管梗阻患者,介入术中首先采用经皮穿刺肾盂,利用常规或者改良微导丝贯通技术逆行置入输尿管支架,若无法行微导丝贯通,则行经皮穿刺肾盂造瘘术。综合介入方法能够解除恶性输尿管梗阻患者的梗阻症状,明显降低患者的肌酐水平,改善患者的肾功能,值得推广。     

顺行放置双猪尾巴输尿管支架治疗恶性输尿管狭窄

目的　探讨对盆腔原发或转移性肿瘤合并尿路梗阻的患者动脉插管化疗前后采用经皮穿刺顺行输尿管支架置放术的技术方法及可行性。方法　对 7例恶性肿瘤伴输尿管狭窄的患者行经皮穿刺顺行放置输尿管支架 ,联合动脉插管化疗。随访时间 2～ 8个月 ,平均 5个月。结果　 7例输尿管支架置放术均获成功 ,病人尿路梗阻解除 ,能耐受动脉插管的常规化疗剂量。 1例出现反复血尿及尿路感染 ,余 6例无严重并发症。结论　对恶性肿瘤导致输尿管狭窄、梗阻的病人在动脉插管化疗过程中顺行放置输尿管支架解除尿路梗阻 ,是一种简便、有效、可行、并发症少的介入治疗方法     

DSA引导下顺行植入输尿管支架在恶性肿瘤所致输尿管狭窄的优势分析

目的 探讨DSA引导下经皮穿刺肾盏置入输尿管支架在恶性肿瘤所致输尿管狭窄的可行性.方法 收集2012年10月至2015年4月因恶性肿瘤导致输尿管狭窄伴肾积水40例患者、45条输尿管狭窄.应用C臂CT成像技术,经皮肾穿刺肾盏,在导管导丝的辅助下植入输尿管支架,解除输尿管梗阻.其中30例在输尿管镜或膀胱镜下植入输尿管支架操作失败并采取DSA引导下植入支架;10例直接行DSA引导下植入支架.35例为单侧输尿管狭窄,5例为双侧狭窄,共45条输尿管受累.分析DSA引导下顺行植入输尿管支架的优势.结果 45条受累输尿管中42条输尿管例植入输尿管支架取得成功,3条因导管导丝未能通过狭窄段未能置入,于患侧留置外引流管缓解肾盂积水.结论 对于恶性肿瘤所致输尿管狭窄患者,DSA引导下经皮肾穿刺植入输尿管支架的方法简便易行,成功率高,并发症少,术后生活质量好.     

输尿管狭窄和梗阻的介入治疗

输尿管狭窄、梗阻或瘘的介入治疗，方法包括球囊扩张双J管、金属内支架置入术及经皮肾盂造瘘术(PCN)。结合使用腔内内镜技术使得该技术更加完善，在临床应用中均取得良好的疗效。我们对天津第二中心医院自1998年6月至2002年4月19例输尿管狭窄性病变的介入治疗包括介入治疗的插管技术及疗效总结如下。     

良性输尿管狭窄和梗阻的介入球囊扩张成形治疗

目的 :评价输尿管良性狭窄和梗阻的介入治疗效果。方法 :对 2 5例良性输尿管狭窄和梗阻患者 ,分别采用经皮肾盂穿刺顺行扩张法和经尿道逆行扩张法 ,并置入双“J”支架管进行内引流治疗。结果 :2 5例共对 2 7侧输尿管进行扩张治疗 ,成功 2 3例(2 5侧 ) ,失败 2例。随访 6～ 5 8个月 ,患者临床症状减轻或消失 ,感染得到控制 ,肾功能好转、尿流动力学、IVP、B超和放射性肾图检查不再出现梗阻现象。结论 :良性输尿管狭窄和梗阻的介入球囊扩张治疗 ,具有创伤小 ,操作简单 ,治疗效果显著     

老年食管恶性狭窄金属内支架植入的姑息性治疗

目的　探讨金属内支架置入治疗老年食管恶性狭窄的疗效。方法　本组 2 8例 ,男 17例 ,女 11例 ,年龄 61～ 78岁。在X线电视透视下 ,对狭窄部位扩张后 ,共置入支架 2 8枚。结果　所有病人的支架留置均获成功 ,患者的生活质量均得到提高。结论　金属内支架植入术是治疗老年食管恶性狭窄的有效的姑息性治疗。     

应用金属内支架治疗食管及贲门部恶性狭窄

目的：评价金属内支架治疗食管及贲门部恶性狭窄的效果。材料和方法：１４例食管，贲门部恶性狭窄患者，１例合并有食管气管瘘。经口操作，先行球囊导管对狭窄段进行扩张，后置入金属内支架，其中１３例置入国产被覆涤纶膜Ｚ型内支架（共１５枚）。另１例应用Ｓｔｒｅｃｋｅｒ ｓｔｅｎｔ。结果：内皮架置入全部成功，术后患者狭窄得到改善，食管气管瘘孔安全封闭。术后患者平均生存时间为５．５个月。结论：金属内支架是治疗食管及     

Experience with a new ureteral stent made of a biocompatible copolymer

A double-pigtail ureteral stent made from a biocompatible copolymer was designed for antegrade insertion with a new coaxial system. Thirty-eight of these stents were successfully placed in 33 patients. Of eight stents used for benign temporary indications, two (two patients) occluded prematurely. One of these patients had retained stone fragments, which caused the 10-F stent to occlude 4 months after balloon dilation of a midureteral stricture. The second patient had a ureteroconduit stricture that was dilated and stented, but mucus occluded the 10-F stent 5 days after insertion. In 25 of the patients, 30 stents were placed for ureteral obstruction due to malignant neoplasms. Three patients died with patent stents, while surviving patients with malignancies continue to have functioning stents, for an overall mean patency of 5.1 months in these patients. No problems related to stent migration or brittleness have been encountered.     

Balloon catheter dilation of ureteroenteric strictures: long-term results

Balloon catheter dilation of benign ureteroenteric anastomotic strictures has been proposed as an alternative to either surgical revision or chronic ureteral stenting, with moderately successful short-term results reported by several groups in a limited number of patients. However, the authors' experience with 29 patients exhibiting 37 benign ureteroenteric strictures treated over the past 7 years revealed that in the majority of cases (23 patients, 26 strictures [70%]), strictures recurred within 6 months of balloon catheter dilation/ureteral stent therapy. Furthermore, of the 11 strictures that appeared to have been successfully dilated at a follow-up interval of 6 months, five restenosed within 1 year. Therefore, only six of 37 (16%) ureteroenteric stricture dilations could be considered successful when viewed at least 1 year after interventional therapy. Furthermore, repeat dilations have often been required to maintain ureteral patency in these patients.     

逆行法介入治疗输尿管良性狭窄

目的探讨输尿管良性狭窄的介入治疗方法及疗效。方法对19例患者20处输尿管良性狭窄病变行球囊扩张并放置双猪尾输尿管支架。结果16例成功,3例失败。失败者1例为迷走血管压迫,1例为纤维索带压迫,1例为输尿管极度迂曲致导丝插入失败。16例成功者经静脉肾盂造影及B超复查显示肾盂积水逐步缓解,肾功能改善,2例输尿管支架尾端进入输尿管内形成医源性异物,后经输尿管镜取出。结论输尿管良性狭窄的介入治疗具有创伤小、操作简单等优点,为输尿管良性狭窄的患者提供了新的治疗方法。     

良恶性输尿管狭窄经皮穿肾经尿道双途径联合介入治疗

目的评价输尿管良、恶性狭窄和梗阻的双途径介入治疗效果。方法对131例良、恶性输尿管狭窄或梗阻患者,采用经皮肾穿刺及经尿道双途径方法进行治疗。结果131例,良性狭窄125例,共对149侧输尿管进行扩张治疗,成功123例(149侧),失败2例。6例恶性狭窄或闭塞,共9侧输尿管进行扩张治疗均获成功。随访6个月~10年,患者临床症状减轻或消失,感染得到控制,肾功好转或恢复,不再出现梗阻现象。结论经皮穿肾经尿道双途径联合介入治疗良恶性输尿管狭窄和梗阻,创伤小,并发症少,操作简单,治疗效果显著。     

Initial Experience with the Resonance Metallic Stent for Antegrade Ureteric Stenting

Background and purpose We describe our initial experience with a new metallic ureteric stent which has been designed to provide long-term urinary drainage in patients with malignant ureteric strictures. The aim is to achieve longer primary patency rates than conventional polyurethane ureteric stents, where encrustation and compression by malignant masses limit primary patency. The Resonance metallic double-pigtail ureteric stent (Cook, Ireland) is constructed from coiled wire spirals of a corrosion-resistant alloy designed to minimize tissue in-growth and resist encrustation, and the manufacturer recommends interval stent change at 12 months. Methods Seventeen Resonance stents were inserted via an antegrade approach into 15 patients between December 2004 and March 2006. The causes of ureteric obstruction were malignancies of the bladder (n = 4), colon (n = 3), gynecologic (n = 5), and others (n = 3). Results One patient had the stent changed after 12 months, and 3 patients had their stents changed at 6 months. These stents were draining adequately with minimal encrustation. Four patients are still alive with functioning stents in situ for 2–10 months. Seven patients died with functioning stents in place (follow-up periods of 1 week to 8 months). Three stents failed from the outset due to bulky pelvic malignancy resulting in high intravesical pressure, as occurs with conventional plastic stents. Conclusion Our initial experience with the Resonance metallic ureteric stent indicates that it may provide adequate long-term urinary drainage (up to 12 months) in patients with malignant ureteric obstruction but without significantly bulky pelvic disease. This obviates the need for regular stent changes and would offer significant benefit for these patients with limited life expectancy.     

Retrograde or antegrade double-pigtail stent placement for malignant ureteric obstruction?

AIM: To determine the optimum approach for double-pigtail stent placement in malignant ureteric obstruction. PATIENTS AND METHODS: Retrograde stent placement was attempted in a consecutive series of patients presenting with malignant ureteric obstruction. If retrograde stent placement was unsuccessful, percutaneous nephrostomy was performed immediately followed by elective antegrade stent placement. Identical digital C-arm fluoroscopy for image-guidance and conditions for anaesthesia and analgesia were employed for both retrograde and antegrade procedures. Identical 8 Fr (20-26 cm) double-pigtail hydrophilic coated stents were used for each approach. RESULTS: Retrograde placement was attempted in 50 ureters in 30 patients {19 male, 11 female, average age 61.4 yr (range 29-90 yr)} over a 24-month period. The success rate for retrograde ureteric stent placement was 50% (n = 25/50). Technical failures were due to failure to identify the ureteric orifice (n = 22), failure to cross the stricture (n = 1), failure to pass the stent (n = 1) and failure to pass a 4 Fr catheter (n = 1). Antegrade placement was attempted in 25 ureters with a success rate of 96% (n = 24/25). Failure in the one case was due to inability to cross an upper third stricture secondary to pyeloureteritis cystica. CONCLUSION: It is suggested that retrograde route should be the initial approach if imaging shows no involvement of ureteric orifice (UO), when nephrostomy is technically very difficult or in cases of solitary kidney. The antegrade route is preferred if imaging shows tumour occlusion of the UO or if there is a tight stricture very close to the uretero-vesical junction (UVJ) making purchase within the ureter difficult for crossing the stricture.     

Antegrade double J ureteral stenting for ureteric strictures: use of silicone stents

In 16 patients with ureteric strictures, silicone double J ureteral stents were inserted antegradely following percutaneous nephrostomy. In 9 patients prior attempt at retrograde placement of a stent had failed. Balloon dilatation of the stricture using angiographic catheters was also performed in 5 patients. The ureteric strictures were most commonly caused by malignant infiltration, post operative fibrosis, infection and ureteric calculi. Most previous reports have described the use of polyethylene and polyurethrane stents. Technical problems with the use of silicone stents are discussed. Although silicone stents are better tolerated by patients and associated with low complication rates, in 5 of 18 stents inserted (28%) the procedure failed. Suboptimal positioning of the stent due to poor radio-opacity and premature occlusion were the causes. With the availability of co-polymer stents, it is likely that these will replace silicone stents as the stent material of choice for antegrade insertion.     

食管恶性狭窄内支架治疗和良性狭窄球囊扩张后的随访评价

目的　评价食管恶性狭窄内支架治疗和良性狭窄球囊扩张后的长期随访疗效。方法92例食管狭窄做了内支架或球囊扩张 ,有较完整的随访资料。 5 9例恶性食管狭窄均置入了内支架 ,其中置入支架前后行放射治疗 (简称放疗 )和 (或 )化学药物治疗 (简称化疗 ) 3 7例 ,占 63 % ;3 3例良性食管狭窄做了单纯球囊扩张治疗。内支架置入类型 :国产镍钛记忆合金网孔支架 2 4例 ,带膜支架2 2例 ;国产GianturcoZ形支架 7例 ,带膜支架 4例 ;Ultreflex支架 2例。门诊行食管造影和内窥镜检查随访 78例 ,14例通过电话或信件随访。结果　本组病例经过 1～ 4 1个月的随访观察 ,仅 1例支架发生轻度移位 ,但仍能覆盖病变全长。食管恶性狭窄 17例死亡 ,术后生存时间 2～ 3 0个月 ,平均 8 2个月。死亡原因 :肿瘤多脏器转移 15例 ,心肌梗死 1例 ,其他原因引起死亡 1例。恶性食管狭窄内支架置入后再狭窄 11例 ,因食物在支架内阻塞 1例 ,发生食管 气管瘘 1例 ,因肿瘤组织生长发生狭窄 8例 ,因支架上端组织增生发生狭窄 1例。发生再狭窄的 11例均再次做了内支架置入或球囊扩张治疗。结论　中晚期食管癌内支架置入是解除吞咽困难有效的姑息治疗方法 ,应用带膜支架和同时行放疗、化疗可防止因肿瘤生长而发生再狭窄 ,延缓患者生命。球囊扩     

Indwelling angiographic catheters to facilitate placement of ureteric stents

In 16 of 191 patients the initial attempt to place a double-pigtail internal ureteric stent by conventional methods was unsuccessful. These patients had cancers of the rectum (nine patients), bladder (two patients), vagina (one patient), cervix (one patient) or spermatic cord (one patient) or radiation strictures (two patients). When a guide wire could be advanced beyond the stricture, placement of a small angiographic catheter for 7 to 10 days allowed delayed placement of the stent in all but one case.     

Self-expandable metal stents in the management of cervical oesophageal and/or hypopharyngeal strictures

AIM: To assess the usefulness of self-expandable metal stents in the recanalization of cervical and/or hypopharyngeal strictures. MATERIALS AND METHODS: We report our experience in 10 patients with inoperable cervical and/or hypopharyngeal strictures treated by implantation of 11 uncovered self-expandable metal stents inserted perorally under fluoroscopic guidance. The stent was placed in the hypopharynx and cervical oesophagus in 3 patients and cervical oesophagus alone in 7. There were 8 men and 2 women, mean age 70.2 years, range 45-85 years. All patients but two had malignant stricture caused by squamous cell carcinoma, in one case there was a benign postoperative stenosis secondary to laryngectomy, and in the last patient a local recurrence from thyroid cancer. RESULTS: Eleven stents were placed in 10 patients: technical success was achieved in 9 cases while clinical improvement was obtained in 8 cases. Seven of ten patients had a rapid improvement of dysphagia. One patient had a distal misplacement of the prosthesis, while in the other two cases stent position was very proximal and interfered with swallowing. A mean 9-month follow-up was obtained (range 3-24 months). Four patients with malignant stricture developed proliferation of neoplastic tissue after 2-5 months. The only patient treated for a benign stricture developed inside proliferation of granulation tissue after 4 months. CONCLUSION: Despite several technical difficulties and a high rate of late complications, recanalization of cervical oesophageal strictures by self-expandable metal stents allowed good palliation of symptoms. Stents proved to be effective and well tolerated palliative treatment also for hypopharyngeal stenoses.