摘要
目的探讨经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术在腔内治疗移植肾输尿管狭窄中的安全性及有效性。方法回顾性分析2007年5月-2017年12月于该院治疗的43例移植肾输尿管狭窄患者的临床资料。平均年龄35.7岁,输尿管膀胱吻合口狭窄平均长度0.75 cm,输尿管行程段狭窄平均长度0.70 cm。术中采用经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术对移植肾输尿管狭窄或闭锁段行电刀内切开和球囊扩张术,术后留置输尿管内支架管或金属支架。结果43例移植肾输尿管狭窄患者中,经尿道逆行输尿管镜治疗组20例,联合经皮肾穿刺顺行输尿管镜技术治疗23例,平均手术时间为(53.3±10.5)min,30例经腔内治疗痊愈,其中一期治疗成功13例,17例行2或3次腔内球囊扩张后治愈;13例反复狭窄复发予以留置镍钛形状记忆合金支架,其中5例留置新型金属覆膜支架,术后随访时间为3~36个月,实验室复查血清肌酐(Scr)(143.4±28.0)μmol/L。结论采用经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术等腔内治疗途径,处理移植肾输尿管狭窄是安全、有效及可靠的。
Objective To investigate the safety and efficacy of minimally invasive percutaneous antegrade and transurethral retrograde ureteroscopy in treatment of transplanted kidney ureteral stricture.Methods The clinical data of 43 patients with ureteral stricture from May 2007 to December 2017 were retrospectively analyzed.Minimally invasive percutaneous antegrade and ureteral retrograde ureter were used.Endoscopic treatment such as mirror technique,electrosurgical incision or balloon dilatation in the ureteral stricture or atresia of the transplanted kidney,postoperative placement of NiTi shape memory alloy stent or ureteral stent tube,regular review and evaluation of renal function variety.Results Of the 43 patients with renal ureteral stricture,20 underwent transurethral retrograde ureteroscopy,23 underwent minimally invasive percutaneous antegrade combine with transurethral retrograde ureteroscopy.The operation time was average(53.3±10.5)min.There were 17 patients underwent 2 to 3 times intraluminal balloon dilatation,13 cases of NiTi shape memory alloy stent,5 cases of new type NiTi memory stent(Allium Stents).After 3 to 36 months of follow-up,The Scr was average(143.4±28.0)μmol/L.Conclusion Minimally invasive percutaneous antegrade and transurethral retrograde ureteroscopy for the treatment of ureteral stricture is safe,effective and reliable,especially for stenosis and obstruction repeatedly.
作者
李协照
朱锐
赵海波
杨炜青
陈金兰
盛明
刘兴
李逊
徐桂彬
Xie-zhao Li;Rui Zhu;Hai-bo Zhao;Wei-qing Yang;Jin-lan Chen;Ming Sheng;Xing Liu;Xun Li;Gui-bin Xu(Department of Urology,the Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510700,China)
出处
《中国内镜杂志》
2020年第5期43-47,共5页
China Journal of Endoscopy
基金
广州医科大学高水平大学学术骨干培育计划(No:广医大发[2017]210号)。
关键词
输尿管狭窄
移植肾
腔内治疗
球囊扩张
金属支架
ureteral stenosis
transplanted kidney
endovascular treatment
balloon dilation
metallic ureteral stent
