覆膜尿路支撑网应用于输尿管狭窄治疗的安全性和有效性

 目的 探讨覆膜尿路支撑网在输尿管狭窄(US)治疗中应用的安全性和有效性。方法 回顾性分析武警重庆总队医院2019-12至2021-11收治的使用覆膜尿路支撑网治疗的23例US患者临床病历资料。采用经皮肾镜下顺行或输尿管镜下逆行方式,先行狭窄段球囊扩张后,内镜直视下释放覆膜尿路支撑网。术中配合C形臂X线透视确认支架位置,顺行或逆行造影确认狭窄部位恢复通畅。收集患者一般信息,狭窄部位、性质,以及手术时长、手术是否成功、术后肾功能、肾积水等情况。结果 23例中,恶性狭窄10例,良性狭窄13例。狭窄病变位于UPJ或上段输尿管处11例,位于中段输尿管处5例,位于下段输尿管处7例。狭窄病变长度4～15 mm,平均(10.0±3.9)mm。均成功置放覆膜尿路支撑网,手术时间50～127 min,平均(87.3±11.5)min。术后1个月和3个月,患者尿素氮和肌酐水平均显著低于术前(P＜0.05),肾小球滤过率均显著高于术前(P＜0.05);患侧肾积水较术前明显减轻;未发生支架移位、尿路感染、结石黏附等支架管相关并发症。结论 针对US的治疗,覆膜尿路支撑网的应用安全有效。

Safety and efficacy of the application of coated ureteral tract support net in treatment of ureteral stricture

Objective To investigate the safety and efficacy of coated ureteral tract support net in the treatment of ureteral stricture. Methods Retrospective analysis of the clinical records of 23 patients with ureteral stricture treated with coated ureteral tract support net in Chongqing Municipal Corps Hospital of Chinese People's Armed Police Force from December 2019 to November 2021. After the expansion of the balloon in the stenosis section, using percutaneous nephrodoscopic anterograde or ureteroscopic retrograde mode, the coated urinary tract support net was released under direct vision under endoscopy. During the operation, C-arm X-ray fluoroscopy was used to confirm the position of the stent, and anterograde or retrograde angiography was used to confirm the patency of the stenosis. Data were collected ,including patient's general information, the location of the stenosis, the nature, the duration of the operation, the result of the operation, postoperative renal function, and hydronephrosis, etc. Results Of the 23 cases, ten were malignant stenosis and thirteen were benign stenosis. There were 11 cases of stenosis located at UPJ or upper ureter, 5 cases at middle ureter, and 7 cases at lower ureter. The mean length of the stenosis was (10±3.9) mm (4-15 mm). The operation duration was (87.3±11.56) min (50-127 min). At 1 and 3 months after surgery, the levels of urea nitrogen and creatinine were significantly lower than those before surgery (P<0.05), and the glomerular filtration rate was significantly higher than that before surgery (P<0.05). The hydronephrosis on the affected side decreased significantly. No stent displacement, urinary tract infection, stone adhesion or other stent related complications occurred. Conclusions For the treatment of ureteral stricture, the application of coated ureteral tract support net is safe and effective.