电切镜联合输尿管镜在腺性膀胱炎中寻找困难输尿管开口的应用

目的探讨电切镜联合输尿管镜在腺性膀胱炎中寻找困难输尿管开口的方法,提高内镜下置入双J管的成功率。方法回顾性分析2015年3月-2016年5月,8例腺性膀胱炎合并有困难输尿管开口的患者的临床资料。均为男性患者,年龄38~64岁,平均44.3岁。电切膀胱内病变,切除深度为黏膜下层和肌层,将输尿管开口区域的坏死组织切除干净,切除深度能够显露肌层的纹理改变。进一步切除肌肉组织,透过薄层肌肉组织能够看见尿液。在导丝引导下置入输尿管镜,镜下观察证实为输尿管管腔。在导丝引导下留置双J管一根。结果 8例患者(16侧)均应用电切镜联合输尿管镜成功置入双J管。手术时间35~205 min,平均时间83.2 min,术中失血量约20~50 ml。术后3~5天拔除尿管。术后1或2天复查腹部平片,显示双侧双J管位置良好,没有出现异位、扭曲等现象。围手术期未出现并发症。结论应用电切镜联合输尿管镜在腺性膀胱炎中寻找困难输尿管开口,能够提高寻找输尿管开口成功的概率,此方法安全、创伤小、避免开放手术。     

上尿路结石腔内治疗术后留置双J管致严重血尿分析

目的探讨上尿路结石腔内治疗术后留置双J管导致严重血尿的原因及防治措施。方法回顾分析11例上尿路结石腔内治疗后留置双J管导致严重血尿病例的资料。结果11例于出院1周后出现不同程度肉眼鲜红血尿及膀胱刺激症状,活动后加重,2周后11例血尿无好转,血常规血红蛋白(Hb)均较出院时下降≥20g/L,1例需输血治疗,5例出现腰痛及发热,KUB示4例出现输尿管石街形成,4周时中段尿培养8例,阳性3例。11例拔管时8例出现双J管表面钙盐沉积。结论双J管在上尿路结石腔内治疗术后作为支架及引流方面有重要作用,但亦可导致严重血尿的并发症。正确掌握腔内手术操作技巧、术后避免过度活动、多饮水、口服抗生素及抑石药物防止感染、缩短留管时间等,可有效地防止严重血尿的产生。     

后腹腔镜下双J管置入新方法

目的探讨后腹腔镜下细钢丝双侧孔内置法双J管置入术的应用体会。方法回顾性分析该院2017年5月-2019年5月采用后腹腔镜下输尿管切开取石的32例患者的临床资料。19例为斑马导丝内置法双J管置入术(A组),13例为后腹腔镜下细钢丝双侧孔内置法双J管置入术(B组),比较两种方法的临床效果。结果所有患者均顺利在腔镜下完成手术,术后复查腹部平片双J管位置均良好。其中,A组双J管置入平均时间(16.32±6.04)min,B组双J管置入平均时间(4.77±1.80)min。结论后腹腔镜下细钢丝双侧孔内置法双J管置入术操作简单,效果良好,并可明显缩短手术时间,值得临床推广。     

Ureteral double J stent displaced into vena cava and management with laparoscopy: A case report and review of the literature

We reported displacement of a ureteral double J stent into the vena cava and laparoscopic management in a 69-year-old patient with a history of ureteral stent placement. Preoperative computed tomography and plain X-rays showed malpositioning of the double J stent and displacement into the inferior vena cava. The characteristics of stent misplacement precluded endovascular procedures and explorative laparoscopic surgery was performed. The intra- and postoperative periods were uneventful. Postoperative imaging demonstrated that the new double J stent was in the right position. The patient was discharged 7 d after the operation and was symptom free at the 4-mo follow-up.     

Modified technique for difficult ureteral stenting in percutaneous nephrolithotomy via inferior calyx approach

Abstract

Percutaneous nephrolithotomy (PCNL) via single inferior-calyceal tract is suitable for some partial staghorn calculi mainly located in the inferior calyx. A ureteral stent should be inserted at the end of PCNL to avoid urine leakage or ureteral obstruction by residual calculi. However, antegrade ureteral stenting via the inferior calyx is not always successful due to unfavorable lower pole calyx anatomy. In the present study, we introduced a modified method for difficult stenting. First a 0.038-inch zebra guidewire was retrogradely introduced through the previously inserted ureteral catheter and grasped out of the work sheath by a ureteroscopic forceps to develop a through-and-through guidewire; then an 8 Fr guide catheter was inserted antegradely over the guidewire into the ureter after removing the prior ureteral catheter; subsequently the zebra guidewire was removed and antegradely introduced into the bladder through the guide catheter, followed by antegrade insertion of a double J stent. Of 158 patients, 32 needed modified ureteral stenting; and the lower pole infundibulopelvic angle (LPIA) was measured in 25 patients with and in 57 patients without modified stenting. The results showed that LPIA in patients with modified stenting was much smaller than that in patients without modified stenting (56.0 ± 12.58 and 77.4 ± 11.40, P < 0.0001); when the LPIA is <60^°, the modified technique should be recommended. In summary, the modified technique is simple, time-saving, less invasive and highly successful for difficult ureteral stenting in PCNL via inferior calyx.     

胃肠恶性肿瘤腹膜后转移致急性肾功能衰竭的诊治

目的探讨胃肠恶性肿瘤腹膜后转移引起肾后性急性肾功能衰竭的诊断治疗。方法对21例晚期胃肠恶性肿瘤(其中直肠癌8例、结肠癌3例、胃癌6例、贲门癌1例、不明原发病灶的转移性腺癌3例腹膜后转移)引起肾后性急性肾功能衰竭患者回顾性的诊治分析。结果行开放肾造瘘7例(包括探查并行开放肾造瘘3例),穿刺肾造瘘5例(后也改为开放肾造瘘),经皮肾穿刺扩张肾造瘘1例,经膀胱镜放置双J管引流2例,膀胱造瘘2例(膀胱出口梗阻),所有经过以上尿液引流的病人肾功能都恢复正常,并且生存时间延长,血液透析2例、放弃治疗2例病人都在较短时间内死于肾功能衰竭及其并发症。结论早期诊断早期治疗肾后性肾功能衰竭可以明显提高了病人的带瘤生存时间,在放置双“J”管引流失败的情况下,肾造瘘是简单、安全、有效的解除肾后性急性肾功能衰竭治疗方法,而不能依赖血液透析治疗。     

肾输尿管结石放置输尿管内支架管患者发生并发症的原因分析及护理对策

目的探讨肾输尿管结石放置输尿管内支架管患者并发症的发生原因及护理对策。方法回顾性分析并总结2014年1月至2015年10月首都医科大学附属北京同仁医院收治的58例肾输尿管结石手术植入输尿管支架管患者的临床资料。结果 58例患者中,发生腰部不适与疼痛51例、血尿35例、膀胱刺激征24例、膀胱输尿管反流17例及输尿管支架管移位5例、引流不畅3例、尿路感染1例。经积极治疗及护理,56例患者痊愈出院,2例膀胱刺激征患者好转,住院时间为10~30d。结论对放置输尿管内支架管患者给予积极有效、有针对性的护理,有利于减少并发症的发生,提高手术效果。     

输尿管镜术后双J管异位的原因及其防治(附15例报告)

目的总结输尿管镜术后双J管异位的原因及防治。方法回顾性分析2003年6月至2009年3月输尿管镜术中放置双J管术后异位的15例:上移异位3例,下移异位11例,泌尿系外异位1例。结果3例上移异位患者均通过输尿管镜取出双J管;11例下移异位患者给予提前膀胱镜取出双J管;1例泌尿系外异位双J管于膀胱镜下重新逆行置管。结论留置双J管是防治输尿管镜术后并发症的首选方式;正确掌握适应证、双J管长度、拔管时间、术中操作等可以有效避免严重并发症的发生。术后紧密追踪观察是减少双J管异位的关键。     

Application of resonance metallic stents for malignant ureteral obstruction

Abstract

Purpose: To determine the effectiveness of the Resonance metallic stent in treating malignant ureteral obstruction (MUO) and clarify the risk factors that lead to stent failure.

Material and methods: We retrospectively identified and analyzed the records of patients who had MUO and underwent placement of Resonance metallic stents from November 2014 to June 2017 in our hospital. Stent failure was defined as unexpected interventions including stent exchange, need of percutaneous nephrostomies (PCN) or ureterocutaneostomy.

Results: A total of 22 stents were placed in 14 patients with MUO. The median follow-up was 145?days (4.8?months) and the maximum duration of stenting was 21.3?months. The technique success rate was 100%. Two patients experienced early postoperative increasing creatinine with oliguria but only one of them failed to achieve primary patency. The overall success rate was 90% (9/10).

Conclusion: Resonance metallic stent is a safe and effective treatment for MUO and can maintain durable patency over 12?months. Preoperative urinary tract infection (UTI) and tumor invasion into the bladder are considered as risk factors of stent blockage and failure. Early postoperative elevated creatinine oliguria, suggestive with intrarenal and prerenal disease, should not be deemed to be stent failure.     

完全腹腔镜下膀胱根治性切除-原位回肠新膀胱术中经尿管逆行置入双J管的应用效果

目的 探讨完全腹腔镜下膀胱根治性切除-原位回肠新膀胱术中经尿管逆行置入双J管的应用效果。方法 回顾性分析2020年9月－2021年10月该院5例行完全腹腔镜下膀胱根治性切除-原位回肠新膀胱术，并于术中经尿管逆行置入双J管患者的临床资料。结果 5例患者在完全腹腔镜下行全膀胱全切，采用经尿管逆行放置双J管，在术后均未出现严重并发症。新膀胱术中置入双J管，操作时间2～4 min，单侧平均置入时间为（2.8±0.6）min，住院时间为（13.0±0.8）d。5例患者术后排尿恢复较好，且在病情恢复过程中均未发生尿漏和感染。结论 在完全腹腔镜下膀胱根治性切除-原位回肠新膀胱术中，应用经尿管逆行置入双J管的方法，取得了良好的应用效果，可以在不破坏气腹的同时缩短手术时间，有利于患者术后排尿功能的恢复，其是一种在新膀胱术中安全、有效且便捷的辅助手段。     

输尿管狭窄的介入治疗(附10例报告)

目的 探讨输尿管狭窄介入治疗的插管技术及提高疗效的方法。方法 10例经IVP或逆行造影确诊的输尿管狭窄的病人,用改制的输尿管导管引入导丝、直头导管扩张狭窄段后再行球囊扩张、双J管及内支架置入,20－30天拔出双J管。结果 除1例未成功外,9例均完成了球囊扩张及双J管置入术。拔出双J管后复查IVP见狭窄段明显扩张,肾盂积水明显改善。其中1例1年后又狭窄,再次行球囊扩张及内支架置入后1年未再狭窄。结论 用改制的输尿管导管插管,直头导管及球囊扩张术治疗输尿管狭窄,技术成功率高。而双J管及内支架置入能明显提高疗效。     

Huge encrusted ureteral stent forgotten for over 25 years: A case report

BACKGROUNDUreteral stent insertion is a relatively non-invasive procedure commonly used in the field of urology to resolve urinary obstruction. However, they are sometimes forgotten and the risk of complications increases with time.CASE SUMMARYA 43-year-old woman with a history of recurrent urinary tract infections visited our hospital for evaluation of persistent left flank pain, and lower urinary tract symptoms despite anti-biotic treatment. She had received urological surgery in her teens but did not know the details of her surgery. Kidney, ureter, and bladder X-ray and abdominopelvic computed tomography revealed a forgotten left ureteral stent with huge encrustation at both ends and a severely dilated left kidney with parenchymal thinning. In order to remove the ureteral stent, a laparoscopic nephroureterectomy was planned. The ureteral stent was successfully removed, and she was discharged after recovery. The patient was followed up for two years after surgery and did not show any signs of long-term complications. CONCLUSIONLong indwelling stents can cause dire complications requiring radical interventions. Stent registry systems, novel stent material development, and proper patient education is important for complication prevention.     

Stents in urology

Ureteral stents are employed in the upper and urethral stents in the lower urinary tract for restitution or maintenance of urinary drainage. Placement of ureteral stents is indicated as an adjuvant measure prior to extracorporal disintegration (ESWL) of large kidney stones to insure urinary drainage and enhance expulsion of fragments and disintegrate. Also, obstruction by very small urinary tract stones that are not treatable by ESWL because they cannot be localized can be relieved by placement of a double-J-stent with immediate elimination of colic. If the cause of urinary tract obstruction is external ureteral compression (retroperitoneal mass), placement of a special tumor stent is one possibility. This, however, has the danger of becoming reobstructed with detritus and blockage of the drainage holes in the stent. In these cases the essential drainage along the stent is blocked by the mass. Therefore, a percutaneous nephrostomy providing direct drainage is easier to control and preferable. Obstructive pyelonephritis is an absolute indication for drainage of the upper urinary tract with a double-J-stent, or even better by percutaneous nephrostomy. If pyeloureteral or ureteral stenoses of the upper urinary tract are opened endoscopically, then the double-J-stent serves to maintain and insure drainage until the new lumen is reepithelialized. In patients with prostatic hyperplasia who no longer respond to medical treatment and who are not candidates for more invasive surgical treatment, a stent can be placed in the prostatic urethra under local anesthesia as a last resort. This procedure is seldom used but, in view of the satisfactory long-term results, it provides a true alternative to bladder drainage by transurethral catheter or percutaneous cystostomy. The same stents may be used in the bulbar urethra to reduce restricture rates following endoscopic treatment of strictures.     

输尿管端端吻合加带蒂大网膜包裹术治疗输尿管下段损伤性狭窄

摘要 目的：探讨输尿管端端吻合术加带蒂大网膜包裹治疗输尿管下段损伤性狭窄的有效性及安全性。方法 从1989年3月至20006年6月,使用输尿管端端吻合加用大网膜包裹治疗输尿管下段损伤性狭窄16例,对临床资料进行了回顾性分析。结果 术后早期漏尿1例,肾萎缩3例。术后4－10周拔除双J管,拔管后再狭窄2例。全部病例术后随访发现输尿管解剖在位,蠕动排空良好,肾积水肾功能得到明显改善。未见有与手术相关的严重并发症。结论 在证实损伤输尿管远段尚有残留后,输尿管端端吻合加带蒂大网膜包裹治疗输尿管下段损伤性狭窄,安全性高,并发症少,实用性强,值得在基层医院推广使用     

双J输尿管支架管生物相容性及新型可生物降解输尿管支架的研制

目的：文章总结近年国内相关文献,了解输尿管支架材料的临床研究和实验研究进展。方法：由第一作者检索2001-01/2010-12万方数据库（http：//www.wanfangdata.com.cn）,检索词为＂输尿管支架,疗效,并发症,生物降解＂。共收集到135篇关于输尿管支架管临床应用及实验研究方面的文献,排除发表时间较早、重复及类似研究,纳入20篇符合标准的文献。结果：在泌尿外科的实践中,输尿管支架管是常用的器械,可以用于尿石症、尿路重建、泌尿系创伤等。它的主要作用是扩张梗阻或狭窄的输尿管将尿液内引流入膀胱,减少肾或输尿管瘘的同时,促进输尿管吻合口的愈合。输尿管支架材料为非生物降解性材料,带管期间患者会出现膀胱刺激症状或发生支架管移位、膀胱输尿管尿液返流和支架管表面结石等并发症。高分子降解性输尿管支架材料体内外生物降解性质的研究处于基础研究阶段。结论：输尿管内支架在泌尿外科中作用显著,但是必需了解及注意预防内支架可能发生的并发症,以便取得更好的疗效。目前各国学者正努力研制更为适宜的输尿管支架材料。     

不同类型输尿管内支架异位的特征及临床治疗方法（附36例报告）

目的 探讨输尿管内支架置入后不同类型位置异常的原因及处理。方法 回顾性分析2014年1月－2020年1月36例在该院置入输尿管内支架并发现位置异常的患者资料,以寻找不同类型内支架位置异常的原因及合适的治疗方法。结果 顺行置管导致内支架位置异常15例,逆行置管导致内支架位置异常20例,1例置入时位置正常但后续操作导致异位;34例在输尿管镜或膀胱镜下取出异位内支架,1例经皮肾造瘘取出内支架,1例开放手术取出异位支架。结论 任何类型置管手术均有支架异位的可能。逆行置管导致内支架位置异常多发生于管腔内,建议膀胱镜下取出,必要时可选择经皮肾造瘘取出;腔内手术顺行置管导致的位置异常,优先考虑输尿管镜下取出,而异位于输尿管腔外的内支架可能需要借助开放手术取管。     

经皮肾穿刺双侧输尿管支架植入术治疗盆腔脂肪增多症伴急性肾衰(附1例报告并文献复习)

目的探讨采用经皮肾穿刺双侧输尿管支架植入术治疗盆腔脂肪增多症伴急性肾衰的可行性和手术效果。方法收治盆腔脂肪增多症伴急性肾衰患者1例,男性,42岁,发热1月,无尿2天,憋气、咳泡沫痰、意识恍惚2小时;膀胱造影提示典型倒梨形膀胱、后尿道延长;腹部CT示盆腔内均匀低密度脂肪堆积、双肾积水、双侧输尿管上段扩张;血肌酐1 031μmol/L、尿素氮23.3 mmol/L。诊断盆腔脂肪增多症伴双肾输尿管扩张积水、急性尿闭、急性肾衰,膀胱镜下逆行插管失败,采用经皮肾穿刺、输尿管下段扩张、输尿管支架植入术方法治疗。结合文献复习讨论经皮肾穿刺输尿管支架植入术治疗盆腔脂肪增多症伴急性肾衰的可行性和手术效果。结果术中经皮肾穿刺造影可见肾盂、肾盏及输尿管上段扩张,输尿管下段管腔狭窄;膀胱造影见典型倒梨形膀胱、后尿道延长。采用经皮肾穿刺、输尿管下段球囊扩张、输尿管支架植入术方法治疗。术后2天拔除尿管,1周后出院。2周后复查彩超示肾盂积水消失,肾功能正常。结论通常情况下盆腔脂肪增多症患者膀胱抬高,后尿道延长,膀胱镜下逆行插管失败率高,经皮肾穿刺、输尿管下段球囊扩张、输尿管支架植入术是治疗盆腔脂肪增多症伴急性肾衰的有效和微创的方法。     

双J管在泌尿外科中的应用(附1580例报告)

目的从实用的角度系统地阐述双J管在泌尿外科上尿路多种疾病中的适应证、置管方法、常见并发症及其处理措施。方法置管1580例,其中输尿管镜治疗上尿路结石1281例(其中65例为经皮肾输尿管镜碎石取石术),输尿管切开取石96例,肾盂输尿管交界狭窄成形42例,肾多发性结石48例,输尿管膀胱再植32例,输尿管狭窄66例,输尿管损伤6例,腹膜后纤维化4例,腹膜后肿瘤5例,上尿路结石切开取石术后尿漏5例。结果内引流与支撑效果良好。置管后主要并发症为膀胱输尿管反流、双J管移位、血尿、管周及管腔结石生成、尿道刺激症状及异物排斥反应。结论留置双J管是治疗上尿路疾病的首选引流方式;正确掌握适应证与拔管时间、针对性作好预防或处理措施,可以有效避免严重并发症的发生。     

上尿路结石术后患者留置双J管出院风险预测模型的构建研究

目的 探索上尿路结石术后留置双J管患者出院风险的危险因素并建立Logistic回归预测模型.方法 选取2020年1—12月在广州市某三级甲等医院进行上尿路结石术后留置双J管435例患者为研究对象,根据留置输尿管支架症状分为阳性组(n=207)和阴性组(n=228),将2组各项指标进行对比,通过Logistic回归分析建...     

B超引导下磁性尿道探条吸出磁性双J管的应用

目的 探讨B超引导下磁性尿道探条取出磁性双J管的应用价值。方法 分析了12例手术后30-62天拔管病人的操作结果。结果 成功10例，失败2例。结论 本项操作可作为经过筛选的病人的首选的拔管方法。