经皮穿刺肾盂微导丝贯通技术在复杂恶性输尿管梗阻输尿管支架置入术中的应用

目的：探讨经皮穿刺肾盂微导丝贯通逆行输尿管支架置入在膀胱镜下输尿管支架置入失败的恶性输尿管梗阻患者治疗中的可行性。方法：收集2016年1月到2017年12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6例，共7条梗阻输尿管，采用经皮穿刺肾盂，利用微导丝建立体外?肾盂输尿管?膀胱?尿道?体外贯通道，然后利用交换导管导丝技术，逆行置入输尿管支架。结果：6例患者7条梗阻输尿管均成功置入输尿管支架，手术成功率100%。所有患者术后均未见肉眼血尿；术后尿内红细胞计数较术前无升高；术后第7天患者肌酐平均值较术前降低，4例术前肌酐异常患者术后均恢复正常；术后第7天所有患者肾盂输尿管扩张较术前明显好转，3例无明显扩张。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，经皮穿刺肾盂微导丝贯通逆行输尿管支架置入术是一种效果好、成功率高、并发症少的介入治疗方法。

Clinical application of percutaneous renal pelvis with microwire penetrating retrogradely ureteral stent implantation in patients with complicated malignant ureteral obstruction

Objective :To evaluate the feasibility of percutaneous renal pelvis with microwire penetrating retrogradely ureteral stent implantation in patients with malignant ureteral obstruction who failed to receive ureteral stent implantation with cystoscope Materials and methods: 6 cases of malignant ureteral obstruction who failed to receive ureteral stent implantation with cystoscope from January 2016 to December 2017 were collected. A total of 7 ureters were obstructed. Percutaneous puncture of the renal pelvis and made the penetraeing way from surface to renal pelvis to Ureter to bladders to urethral and finally to the outside with microwire. Then the ureteral stent were retrogradely imported using the technique of exchanging of the wires and the carters. Results: Ureteral stents were successfully placed in 7 ureteral obstruction among 6 patients, and the technical success rate was 100%. No visible hematuria was found in all patients after operation; The urine erythrocyte count was not becomimg higher than before operation; The average value of creatinine in patients was lower than that before operation on 7 days after operation, and 4 cases of abnormal creatinine patients recovered to normal after operation; All patients with ureterectasis and hydronephrosis were symptomatic improved than before operation and even 3 cases had no hydronephrosis 7 days later after operation. Conclusion: Percutaneous renal pelvis with microwire penetrating retrogradely ureteral stent implantation in patients with malignant ureteral obstruction who failed to receive ureteral stent implantation with cystoscope is an more effective, higher successful rate and less complication interventional therapy.