摘要
目的：初步评价金属输尿管支架置入治疗肿瘤性输尿管梗阻的疗效及并发症发生率。方法回顾性分析2012年7月至2014年1月收治的11例因恶性肿瘤导致输尿管梗阻患者资料，男4例，女7例。年龄28～88岁，平均56岁。2例间断发热，1例患侧腰痛。术前B超及CTU检查均提示患侧肾脏轻至中度积水，5例为双侧梗阻。血肌酐均正常。10例采用膀胱镜或肾镜经尿道逆行置入金属输尿管支架，1例采用经皮肾镜顺行置入。术后6个月复查KUB及B超，如出现反复发热或置入侧腰痛等梗阻症状则提前复查。随访观察疗效及并发症发生情况。结果本组11例中，2例双侧梗阻分期行金属输尿管支架置入，共行置入手术13次；共16侧置入金属输尿管支架，置入成功率100％。术后发热及腰痛症状缓解，复查B超，患侧肾积水均明显缓解。术后随访1～16个月，平均9个月。9例尚未达金属支架更换期限（1年）；2例因全身状况差逾期未更换。1例因尿路上皮癌进展死亡；5例（9侧）复查B超肾积水无进展，金属输尿管支架保持通畅；5例（6侧）金属输尿管支架梗阻，表现为反复发热，复查B超肾积水进展，其中3例结石形成，2例尿路上皮增生。结石形成患者中1例行ESWL治疗后金属输尿管支架复通；1例梗阻支架拔除失败，同侧另置入普通输尿管支架管1根；余3例支架梗阻者均拔除金属输尿管支架后更换普通输尿管支架管。结论金属输尿管支架用于治疗相对稳定的因晚期肿瘤压迫输尿管导致的梗阻安全有效，对于留置金属输尿管支架的患者需定期随访，并在1年内予以更换。对于肿瘤进展快、浸润输尿管管腔或易形成结石的患者应提前至6个月内更换。
Objective To present the primary effectiveness and morbidity of metallic ureteral stent in treating the patients with malignant ureteral obstruction .Methods The retrospective study enrolled 11 patients received metallic ureteral stent placement because of malignant ureteral obstruction at our hospital between Jul.2012 and Jan.2014.Total of 16 stents were inserted including 5 bilateral stent insertion. There were 4 males and 7 females, with a mean age of 56 years （range 28 to 88 years）.Mild to moderate hydronephrosis were identified by ultrasound and CTU in all patients , including 2 recurrent fever and 1 renal colic in affected side , however serum creatinine level is normal .There were 10 patients received stents insertion through cystoscopic or nephroscopic retrograde approach and 1 through nephroscopic antegrade approach,under superficial , spinal or intravenous anesthesia .Patients were scheduled for follow-up at 6 months intervals by KUB and ultrasound and would be examined ahead of time if there were any obstructive symptoms including recurrent fever or renal colic of the affected side .Outcomes and complications were observed during follow-up.Results In total,11 patients underwent 13 operations,including 2 by staging operations.Hydronephrosis , recurrent fever and renal colic were relieved in all patients after operation , showing 100%success rate.The mean follow-up was 9 months,in which,9 patients had not reached the scheduled time （1 year） while 2 patients exceed the time limit of stent exchange because of poor physical status.During the follow-up, 1 patient died of the progression of urothelial carcinoma .Nine stents of 5 patients keep alleviating the obstruction without hydronephrosis evaluated by ultrasonography .Stents failure occurred in 6 ureters of 5 patients, including 3 encrustation and 2 migration, presenting of progressive hydronephrosis and recurrent fever . Functional restoration was achieved in one of the encrusted stent undergoing ESWL .One stent with encrustation fail to be remov
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2015年第10期757-760,共4页
Chinese Journal of Urology
关键词
恶性
输尿管梗阻
金属支架
Malignancy
Ureteral obstruction
Metallic stent
