良性输尿管狭窄球囊扩张术后置入不同输尿管支架的临床效果观察

目的探讨良性输尿管狭窄球囊扩张术后不同输尿管支架置入后的临床效果。方法回顾性分析2018-08—2020-08间于郑州大学第一附属医院行良性输尿管狭窄球囊扩张术后的69例患者的临床资料。根据置入支架分为3组,A组为金属管支架管,B组为双重普通DJ管,C组为单根普通DJ管,每组23例。比较3组患者的基线资料,临床效果及不良反应。结果 3组患者的基线资料及治疗效果差异无统计学意义(P>0.05)。在降低患者术后不良反应方面,A组明显优于B组及C组,有统计学意义(P<0.05),B、C组间差异无统计学意义(P>0.05)。结论对良性输尿管狭窄球囊扩张术后三种支架均可显著改善患者术后肾积水及输尿管狭窄情况。但金属支架在降低腰痛、发热、血尿、尿频尿急症状,及输尿管支架管结石形成等不良反应方面均低于B、C组。     

经尿道球囊扩张术治疗输尿管狭窄的临床疗效及影响因素分析

目的:观察经尿道途径输尿管球囊扩张术治疗输尿管良性狭窄的临床疗效,分析对预后可能存在的影响因素。方法:回顾性分析87例输尿管良性狭窄行经尿道途径输尿管球囊扩张术后的临床疗效,同时分别从年龄、部位、狭窄数量、狭窄长度、肾积水程度、留置输尿管支架管数量及时间、狭窄病因等方面评估影响手术效果的可能因素。结果:所有病例均顺利完成手术,无严重并发症。随访手术总体有效率为71.26%。年龄、部位、留置输尿管支架管数量对手术疗效无明显影响(P0.05)。而输尿管狭窄数量及长度为影响行经尿道球囊扩张术后成功的不利因素(P0.05),OR值为8.366和7.304。轻度肾积水较重度肾积水手术效果更好(P0.05),OR值为0.179。相对于非医源性原因所造成的狭窄,医源性狭窄为手术效果的不利因素(P0.05),OR值为5.045。结论:经尿道途径输尿管球囊扩张术是治疗输尿管良性狭窄行之有效的方法之一,临床医师可根据患者的临床情况评估球囊扩张术的适应证,保证临床疗效。     

24 F球囊扩张治疗输尿管狭窄的疗效及安全性评价

目的探讨输尿管镜或经皮肾镜下使用24 F球囊扩张术治疗良性输尿管狭窄的临床疗效及安全性评估。方法回顾性分析2014年1月至2016年1月龙川县中医院和中山大学附属第三医院输尿管镜下或经皮肾镜下24 F(20例)及18 F(20例)球囊扩张治疗40例良性输尿管狭窄患者临床资料。结果 24 F组中,20例患者均在输尿管镜或经皮肾镜引导下找到正确通道,完成球囊扩张手术。留置单条6 F输尿管内支架管10例,留置双条4.7 F输尿管支架管10例。留置双J管6~12个月。术后随访6~30个月,总体有效率90%(18/20)。18 F球囊扩张总体有效率65%(13/20),两组比较,总体有效率差异具有统计学意义(P0.05)。两种型号的球囊扩张均未发生严重的出血或输尿管损伤。结论输尿管镜或经皮肾镜下24 F球囊扩张术是治疗良性输尿管狭窄安全、有效的手术方法,总体有效率高于18 F球囊扩张术,可以作为狭窄长度在1.0 cm以内的单侧肾功能轻-中度损害的良性输尿管狭窄病例的首选方案。     

经尿道输尿管球囊扩张术治疗肾盂输尿管连接部狭窄58例疗效分析

目的探讨经尿道输尿管镜下球囊扩张法治疗肾盂输尿管连接部狭窄的有效性及安全性。方法回顾性分析2012年2月至2017年10月行经尿道输尿管镜球囊扩张治疗的58例先天性肾盂输尿管连接部狭窄患者的临床资料,通过术后随访结果将患者进行分组,采用单因素分析法及Logistic回归分析探讨影响手术预后的危险因素。结果 58例患者中37例术后2年内未发生再狭窄,有效率为63.79%(37/58)。单因素分析结果显示:狭窄段长度、狭窄程度、球囊扩张时间、留置输尿管支架管条数及带管期间有无感染5项指标在手术有效组与无效组间比较,差异均有统计学意义(P均0.05)。Logistic回归分析发现狭窄长度、狭窄程度及留置2根输尿管支架是影响手术预后的独立危险因素(P0.05)。结论输尿管镜直视下的球囊扩张术可作为狭窄段1.5cm的肾盂输尿管连接部狭窄患者的首选治疗方案,术中留置双根输尿管支架管可有效降低术后再狭窄发生率。     

输尿管镜下逆行球囊扩张术治疗良性输尿管狭窄的临床研究

目的分析影响输尿管镜下逆行球囊扩张术治疗良性输尿管狭窄（US）预后的相关因素。 方法回顾性分析我科2012年10月至2016年10月期间行输尿管镜逆行球囊扩张术治疗的单侧单发的良性输尿管狭窄患者临床资料,总共40例患者,其中男、女各20例,年龄25～76岁,输尿管狭窄段位置位于盂管交界处12例,输尿管上段8例,中段3例,下段17例。输尿管狭窄段的长度0.2～2 cm。均应用U30球囊扩张器扩张,所有患者术后常规留置双J管或者海马管6个月至1年,每3个月更换一次,术后随访1年。 结果手术时间45～90 min,平均60 min。术后2～3 d出院,平均住院日2.5 d,无严重并发症,血尿及尿路刺激征并发症发生率较高,术后随访1年,有效患者25例（62.5%）,无效患者15例（37.5%）。单因素χ²检验及多因素Logistic回归分析显示输尿管狭窄段的长度及术前患侧肾积水程度是影响输尿管镜球囊扩张术预后的主要因素（P<0.05）,而患者的性别、年龄及输尿管狭窄的位置以及狭窄的原因对手术治疗预后无显著影响（P>0.05）。 结论输尿管镜下逆行球囊扩张术是治疗良性输尿管狭窄安全、有效的手术方法。     

输尿管镜钬激光联合球囊扩张与单纯球囊扩张治疗输尿管狭窄的疗效分析

目的 比较输尿管镜钬激光联合球囊扩张与单纯球囊扩张治疗输尿管狭窄的安全性及有效性.方法 回顾性分析2010年1月至2015年1月经本院治疗的45例输尿管狭窄患者,根据其手术方式分为观察组和对照组,观察组为球囊扩张术联合应用Wolf 9硬性输尿管镜钬激光切开治疗输尿管狭窄的25例患者,对照组为应用单纯球囊扩张治疗输尿管狭窄的20例患者,比较两种方法治疗输尿管狭窄的临床效果.结果 25例输尿管狭窄患者顺利应用球囊扩张术治疗,并应用硬性输尿管镜钬激光进行切开,术后放置4.8F双J管2根,随访1～19个月,2例狭窄复发,2例肾积水无明显变化,术后无明显出血、尿瘘和感染等并发症发生,手术有效率为84.00％.20例患者应用输尿管狭窄球囊扩张治疗,术后放置4.8F双J管2根,术后随访1 ～19个月,4例术后狭窄复发,肾积水无明显变化5例,术后无明显出血、尿瘘和感染等并发症发生,手术成功率55.00％.对两种方法治疗输尿管狭窄的临床疗效进行统计学分析(P＜0.05),差异有统计学意义.结论 球囊扩张联合钬激光术治疗输尿管狭窄的疗效优于单纯应用球囊扩张术,是治疗输尿管狭窄的首选方法,具有效果满意、创伤小、安全等优点,值得推广.     

经皮顺行球囊扩张治疗输尿管-肠吻合口狭窄

目的：评价经皮肾穿刺顺行球囊扩张治疗尿流改道术或原位膀胱术后输尿管-肠吻合口狭窄治疗效果。方法：对15例尿流改道术或原位膀胱术后患者，共25处输尿管-肠吻合口狭窄，采用经皮肾穿刺顺行球囊扩张，并置入输尿管支架管6周进行引流治疗。结果：本组15例中，2例双侧和1例单侧狭窄患者因导丝不能通过狭窄处，扩张失败。其余8例双侧狭窄、4例单侧狭窄患者均成功完成扩张，其中9例拔除支架管后症状好转，血肌酐下降及肾积水保持稳定，随访时间3～29个月（平均13个月），有效率60％；另3例拔除支架管后1～3个月，血肌酐进行性上升，予以再次留置输尿管内支架管并定期更换。结论：经皮肾穿刺顺行球囊扩张治疗输尿管-肠吻合口狭窄，创伤小，操作简单，可替代开放手术作为首选治疗方案。     

输尿管良性狭窄内切开前行球囊扩张的临床研究

目的 探讨输尿管良性狭窄内切开前使用球囊扩张的必要性.方法 16例输尿管良性狭窄患者行钬激光输尿管内切开前,6例采用球囊扩张狭窄段,10例采用输尿管硬镜扩张狭窄段.回顾性分析其临床资料和随访结果,包括病因、狭窄部位、诊断方法和超声等随访情况.结果 输尿管硬镜扩张者3例失败,改用球囊扩张成功;使用球囊扩张的患者均扩张成功.狭窄长度为0.8～1.4 cm.用球囊扩张的手术时间短于用输尿管硬镜扩张,但手术费用高于用输尿管硬镜扩张,差异均有统计学意义(P<0.05).随访3～28个月,无围手术期并发症,2例用输尿管硬镜扩张患者出现再狭窄.结论 输尿管良性狭窄内切开前使用球囊扩张安全、有效,但费用较高.     

球囊扩张加双重双J管置入治疗良性输尿管狭窄18例报告

目的观察通过膀胱镜、输尿管镜或经皮肾镜引导下使用输尿管球囊扩张导管加双重双J管置入治疗输尿管良性狭窄的疗效。方法用双腔直头球囊扩张管（头端球囊长4cm）“珠头”导丝、镍钛导丝、高压注射器等设备对18例输尿管良性狭窄的患者进行扩张,扩张后放置双重双J管。结果术后随访6～48个月,术后6～9个月经造影证实肾积水减轻、输尿管扩张部位无狭窄为有效,有效率为66．7oA。按有无手术病史将患者分成两组,统计学检验两组疗效无显著性差异（P〉0．05）。结论球囊扩张治疗输尿管良性狭窄（〈2cm）效果满意。术中放置2根双J管支撑,既有管内引流又有管外引流,对抑制远期输尿管挛缩可能起到了一定作用。但此方法可能对移植肾输尿管膀胱吻合口狭窄治疗效果不满意,需结合腔镜下内切开治疗。     

经输尿管镜球囊扩张术治疗婴儿原发性梗阻性巨输尿管的近期疗效北大核心CSCD

目的探讨经输尿管镜球囊扩张术治疗婴儿原发性梗阻性巨输尿管(primary obstructive megaureter,POM)的近期疗效。方法2021年1~9月我科对16例婴儿POM行经输尿管镜球囊扩张术,在导丝引导下上行F_(4.5)球囊扩张器至输尿管口狭窄处,扩张狭窄处3 min(4个大气压),重复3次,间隔3 min,留置F_(4.7)输尿管支架管1根。结果16例患儿(17侧)顺利施行经输尿管镜球囊扩张术并成功留置输尿管支架管,无中转开腹手术。输尿管支架取出后1个月肾盂前后径、肾皮质厚度和输尿管内径较扩张前明显缩小或增厚(P<0.05)。输尿管支架取出后1个月复查泌尿系超声,9例术后输尿管无扩张,达到治愈;4例输尿管扩张<10 mm,2例输尿管扩张14 mm,继续随访观察;1例输尿管扩张19 mm,肾积水无明显好转,且反复泌尿道感染3个月后改行腹腔镜下Lich-Gregoir手术,术后恢复良好。结论经输尿管镜球囊扩张术治疗婴儿POM安全,短期疗效满意。     

腔内两根双J管治疗单根双J管无效的良性输尿管狭窄疗效观察

目的 探讨对于良性输尿管狭窄的患者,放置单根双J管无效后,改用同侧输尿管腔内放置两根双J管引流的安全性和有效性.方法 对本院2012年1月至2016年4月收治11例良性输尿管狭窄的患者,留置单根双J管无效后,输尿管腔内置入两根4.7F双J管引流,3个月后拔除,拔管后1个月B超或CT测定患者的肾积水的变化.结果 11例患者随访3~12个月,平均6个月.患者都能耐受两根双J管,无明显的腰腹胀痛、发热、肉眼血尿等症状.术后3个月拔管前查腹部平片示双J管无移位,拔管后1个月B超或CT示患者肾积水不同程度减轻或消失.结论 对于良性输尿管狭窄的患者,放置单根双J管无效后,改用同侧输尿管腔内留置两根双J管引流安全有效,但远期效果和机制需要大样本进一步研究验证.     

Balloon dilation for ureteral stricture with stone fragments after ESWL]

We treated 5 cases of severe hydronephrosis with balloon dilation. Those hydronephrosis were due to the ureteral stricture with small stone fragments after ESWL (Lithostar). In each case, in situ ESWL had been done on a long-lodged ureteric stone with severe hydronephrosis. And even after the disintegration of stone with ESWL, hydronephrosis remained due to ureteral stricture with small stone fragments. Balloon dilation was done through percutaneous nephrostomy tract in 4 cases and via retrograde transurethral routine in 1 case. Balloon dilation catheter (7 fr. 6 mm diameter 4-10 cm length, Bard Co.) was used. There was no need for stone extraction. After dilation, ureteric stents (8.2/7 fr.) were kept in place for 4-8 weeks. Intravenous urogram was taken on 4-8 weeks after removing ureteric stents. In all of the 5 cases, improvement of hydronephrosis was remarkable. And there was no residual stone fragments in 4 cases. It is concluded that balloon dilation for ureteral stricture with stone fragments after ESWL is very useful. For the valid evaluation of balloon dilation, further experience and longer observation are requisite.     

膀胱全切原位回肠新膀胱术后输尿管肠吻合口良性狭窄的处理

目的：探讨膀胱全切原位回肠新膀胱术后输尿管肠吻合口良性狭窄的处理方法。方法：我科自2003年1月～2012年6月采用膀胱全切原位回肠新膀胱术治疗395例膀胱癌患者。术后发生输尿管肠吻合口良性狭窄10例,采用输尿管镜扩张、内镜下逆行／经皮穿刺顺行球囊扩张、内镜下狭窄段内切开、开放输尿管膀胱再植术,并留置双J管3～6个月。结果：本组10例中,1例（1处）因导丝不能通过狭窄段而改行开放手术,术后随访36个月,肾积水明显改善。其余9例（11处）采用腔内技术处理,其中3例（4处）采用输尿管镜扩张,2例（3处）采用内镜下狭窄段内切开,4例（4处）采用内镜下逆行／经皮穿刺顺行球囊扩张。术后随访9～72个月（中位25个月）。5例（7处）肾积水明显改善,2例（2处）肾积水长期随访无加重,2例（2处,狭窄段长分别为1．2cm、1．5cm）再发狭窄,遂采用开放手术,分别随访16及24个月,肾积水改善。结论：腔内技术操作简单,创伤小,可作为输尿管肠吻合口良性狭窄的首选治疗方案。开放手术仍然是治疗输尿管肠吻合口狭窄的金标准。对于狭窄段〉1cm的患者,应首先考虑开放手术。     

输尿管狭窄伴息肉样增生性输尿管炎的诊治

目的 探讨输尿管狭窄伴息肉样增生性输尿管炎的诊断与治疗。方法 回顾性分析6例输尿管狭窄伴息肉样增生性输尿管炎患者的临床资料。结果本组6例，输尿管镜检查见输尿管中、下段均存在管腔狭窄（长度平均3．3cm），狭窄段及其近端可见散在淡黄色或淡红色息肉形成。4例行输尿管镜下气囊或镜体扩张，术后予双“J”管引流和抗感染等治疗1月。2例因输尿管狭窄严重，无法行扩张置管，而改行切除输尿管狭窄段，后行输尿管端端吻合术。术后1年随访临床症状无复发，复查腹部平片＋静脉尿路造影输尿管梗阻和肾积水表现消失。结论对于输尿管狭窄伴发输尿管炎者，输尿管镜检查是主要诊断手段，镜下气囊或镜体扩张、双“J”管引流联合抗感染是有效治疗措施。     

同侧两根双J管引流在结石伴息肉导致输尿管狭窄患者中的应用

目的观察同侧两根双J管引流在结石伴息肉导致输尿管狭窄患者中的应用效果。 方法选取2012年1月至2017年6月期间我院收治的输尿管结石伴息肉导致输尿管狭窄患者80例，采用随机数字法将患者分为研究组及对照组，每组各40例。研究组患者腔内碎石术后同侧输尿管内留置两根双J管，对照组患者腔内碎石术后留置单根双J管。根据术中情况，双J管留置4～12周，平均8周。拔管后4周复查血肌酐和泌尿系超声，了解输尿管结石残留情况和肾积水程度，比较两组患者血肌酐、结石清除率和肾积水的变化。 结果拔管后4周，两组患者血肌酐下降和结石清除率差异均无统计学意义（P>0.05）。研究组和对照组手术后肾积水均有明显的改善，肾积水下降值分别为（23.5±7.0）mm vs （20.1±7.3）mm差异有统计学意义（P<0.05）。 结论输尿管结石伴息肉导致输尿管狭窄的患者，输尿管腔内碎石术后同侧留置两根双J管短期引流效果优于留置单根双J管，但远期效果和机制需要大样本进一步研究验证。     

Late complications of ureteral stents

OBJECTIVE: To review morbidity and late complications of ureteral stent insertion and to specifically evaluate hydronephrosis as a radiologic finding of obstruction in the presence of an indwelling ureteral stent. METHODS: In this prospective study, we evaluated 110 stented kidneys in a group of 90 patients. Of 110 stents, 52 were left in place for 3 months, 23 for 6 months, 11 for 9 months, and 24 for up to 12 months. With the stent in place, patients were followed by plain abdominal X-ray 1 and 30 days after stenting. Further follow-up was performed through ultrasound and plain film every 3 months until scheduled date for stent removal or the appearance of complications. RESULTS: In 11 of 110 cases (10%) there was stent fragmentation and in 9 (8.2%) stent migration. In 10 cases (9.1%), there was no change in the severity of the hydronephrosis, but because of flank pain or urinary tract infection with fever, the stents had to be removed. In 6 cases (5.4%) hydronephrosis developed or worsened after stenting. Of the 110 ureteral stents, 32.7% had to be removed because of late complications. CONCLUSIONS: Although ureteral stenting is undoubtedly an important procedure for the release of ureteral obstruction, the indications for stent insertion should be carefully considered in each patient. Late complications of ureteral stents are frequent and appear in one third of the patients. Close follow-up of stented patients is valuable in early detection of morbidity or complications, and in such cases the stent should be removed or exchanged as soon as possible.     

Die Duplex-Doppel-J-Schiene bei intrinsischen und extrinsischen Harnleiterengen

Background

Duplex or twin ureteral stenting has previously been described as a viable option for patients where single double-J ureteral stenting has failed in order to avoid nephrostomies or further surgical intervention. We assessed a series of 20 patients at our institution after unsuccessful primary single ureteral stenting where parallel ureteral stents were inserted.

Methods

Between 2003 and 2009, 20 patients underwent double-J ureteral stenting for ureteral compression or ureteral strictures. After failure of single stenting two ureteral stents were consecutively inserted into the ureter in a parallel fashion after dilating the ureter up to 14 F. The second stent was passed over a hydrophilic guidewire while holding the first stent secure to prevent dislocation.

Results

In all patients the insertion of two parallel stents was technically possible. In 8 of 12 patients with extrinsic tumor compression the stents provided sufficient drainage (67%). When the stricture was due to surgery or radiation two of three patients were successfully diverted with twin stents. In five patients with a ureteral stricture due to malignant disease the stenting did not provide sufficient drainage and a nephrostomy had to be placed after a mean duration of 19 days. Two of those patients were later managed with a pyelovesical bypass. Three patients were later managed with a ureterocystoneostomy (psoas hitch). In four of five patients with benign disease a long-term management was feasible. The patient with retroperitoneal fibrosis developed immediate hydronephrosis and severe flank pain and ultimately underwent an ileal ureter replacement. In three patients with a benign ureteral stenosis after stone therapy, hysterectomy, or colon ureter replacement, a temporary duplex stenting sufficiently resolved the hydronephrosis for spontaneous urine passage. In one patient the duplex stenting prevented a kidney stone from dislocating into the ureter during lithotripsy.

Conclusions

Duplex or twin (double) ureteral stenting is a valid option in selected patients to avoid the placement of a nephrostomy. Severe stenosis may however demand a nephrostomy insertion or more invasive procedures in the later course. For certain benign ureteral strictures a therapeutic dilating effect of the two ureteral stents that makes further intervention unnecessary can be discussed.