内镜下输尿管金属支架逆行置入在肿瘤性输尿管梗阻中的应用价值

王周; 吴玲; 任黎刚; 谢波; 程一宁; 张心男

doi:10.13201/j.issn.1001-1420.2018.04.017

内镜下输尿管金属支架逆行置入在肿瘤性输尿管梗阻中的应用价值

- 1. 浙江省立同德医院泌尿外科(杭州, 310012);
- 2. 浙江省立同德医院病理科

详细信息

通讯作者: 任黎刚,E-mail:ren_lg@aliyun.com

中图分类号: R691.2

收稿日期: 2016-11-08

Clinical value of retrograde metallic ureteral stent under endoscopy treating the patients with malignant ureteral obstruction

- 1. Department of Urology, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China;
- 2. Department of Pathology, Tongde Hospital of Zhejiang Province

More Information

Corresponding author: REN Ligang, E-mail: ren_lg@aliyun.com

Received Date: 08 November 2016

摘要

摘要: 目的:探讨内镜下输尿管金属支架逆行置入在解除肿瘤性输尿管梗阻中的临床价值。方法:回顾性分析2013年4月~2015年10月我院采用内镜下输尿管金属支架逆行置入治疗9例因肿瘤致输尿管梗阻患者的临床资料。男3例,女6例;平均年龄49岁;其中双侧输尿管梗阻5例,单侧4例。所有患者术前均行肾功能、泌尿系彩超及CT扫描或CTU检查,了解肾积水程度及输尿管梗阻部位。9例患者利用输尿管硬镜在X线透视下逆行置入金属支架,术后定期复查肾功能、KUB及腹部CT平扫等。术后每半年或1年更换金属支架管。结果:9例患者均逆行置入金属支架管,其中2例先行导丝引导下球囊扩张后顺利置入。术后KUB均显示输尿管金属支架放置位置合适。5例患者术后24h尿量明显增加,肾功能恢复正常或接近正常。患者术前发热及腰痛等不适症状缓解,术后随访患侧肾积水范围均较术前缩小或明显缓解,2例患者因金属支架下移及金属支架末端附着结石给予提前更换,其余5例均每年更换。结论:内镜下输尿管金属支架逆行置入具有创伤小、恢复快、可重复治疗等优点,是用于治疗因恶性肿瘤压迫输尿管梗阻的有效方法。
- 内镜 /
- 肿瘤 /
- 金属支架 /
- 输尿管梗阻
Abstract: Objective: To investigate the clinical value of retrograde metallic ureteral stent under endoscopy treating the patients with malignant ureteral obstruction.Method: The retrospective study on clinical data of nine patients who received retrograde metallic ureteral stent under endoscopy because of malignant ureteral obstruction between Apr.2013 and Oct.2015 was done.There were three males and six females, whose mean age was 49 years old.Five of them were found bilateral and other four were found unilateral ureteral obstruction.In order to know the degree of hydronephrosis and ureteral obstruction, all patients underwent kidney function testing, ultrasound and CT scan or CTU examination preoperatively.These nine patients were retrogradely implanted metallic ureteral stent under ureteroscopy by X-ray.All of them were reviewed kidney function testing, abdomen KUB and CT scan postoperatively regularly.Result: Nine patients were retrogradely implanted metallic ureteral stent.Two of them were successfully placed by balloon dilation with the wire guide.All patients' stents displayed a suitable position by abdominal X-ray examination postoperatively.Five patients' 24 hours urinary volume increased significantly, and renal function improved excellently with creatinine recovered.Hydronephrosis relieved or disappeared postoperatively in all person, and their fever and back pain also relieved.Two of the patients were exchanged stent in advance because of encrustation and placement, the others were exchanged their stent every year.Conclusion: Treatment of putting metallic ureteral stent retrograde under endoscopy has the advantages of less invasion and rapid recovery.It could be an efficient method for the treatment of malignant ureteral obstruction.
- endoscopic /
- cancer /
- metallic stent /
- ureteral obstruction

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参考文献(16)

[1]	王忠敏, 贡桔, 伍超贤, 等.金属内支架介入治疗恶性输尿管狭窄的临床应用[J].中国介入影像与治疗学, 2006, 3 (1):46-48.
[2]	杨关天, 周翔, 杨正平, 等.腹部肿瘤继发输尿管梗阻的微创治疗[J].中华临床医师杂志 (电子版), 2014, 8 (21):3769-3772.
[3]	Aravantinos E, Anagnostou T, Karatzas A D, et al.Percutaneous nephrostomy inpatientswithtumors of advancedstage:treatment dilemmas and impact on clinical course and quality of life[J].J Endourol, 2007, 21 (11)::1297-2302.
[4]	Rosenberg B H, Bianco F J, Wood D P, et al.Stent change therapy in advanced malignancies with ureteral obstruction[J].J Endourol, 2005, 19 (1):63-67.
[5]	Yachia D.Recent advances in ureteral stents[J].Curr0 pin Urol, 2008, 18 (2):241-246.
[6]	于友涛, 陈辉, 杨光, 等.恶性肿瘤继发输尿管狭窄的超声引导经皮穿刺顺行输尿管支架管置入治疗[J].临床泌尿外科杂志, 2011, 26 (10):738-740.
[7]	操作亮, 章传华, 邱文涛.双J管在晚期盆腔癌输尿管梗阻中的应用[J].临床泌尿外科杂志, 2003, 18 (8):485-486.
[8]	李克军, 陈先国, 宋兴福, 等.输尿管支架在泌尿疾病治疗中的应用及其生物相容性[J].中国组织工程研究与临床康复, 2009, 13 (48):9511-9514.
[9]	高伟, 欧彤文, 吴江涛, 等.金属支架置入治疗恶性肿瘤引起输尿管外压性梗阻[J].中华临床医师杂志 (电子版), 2012, 6 (21):6947-6949.
[10]	Chow P M, Hsu J S, Wang S M, et al.Metallic ureteral stents in malignant ureteral obstruction:short-term results and radiological features predicting stent failure in patients with non-urological malignancies[J].World JUrol, 2014, 32 (3):729-736.
[11]	刘可, 肖春雷, 马潞林, 等.金属输尿管支架置入治疗肿瘤性输尿管梗阻的疗效和初步经验[J].中华泌尿外科杂志, 2015, 36 (10):757-760.
[12]	Chung K J, Park B H, Park B, et al.Efficacy and safety of a novel, double-layered, coated, self-expandable metallic mesh stent (UventaTM) in malignant ureteral obstructions[J].J Endourol, 2013, 27 (7):930-935.
[13]	Sountoulides P, Kaplam A, Kaufmann O G, et al.Current status of metal stents for managing malignant ureteric obstruction[J].BJU Int, 2010, 105 (8):1066-1072.
[14]	Soria F, Rioja L A, Morcillo E, et al.New combined approach in metallic ureteral stenting to avoid urothelial hyperplasia:study in swine model[J].J Urol, 2011, 185 (5):1939-1945.
[15]	薛东炜, 刘春来, 张西玲, 等.肿瘤用输尿管支架管治疗恶性输尿管梗阻的临床应用[J].中国医科大学学报, 2014, 43 (5):468-469.
[16]	刘伟, 田跃军, 李谛音, 等.金属支架在慢性输尿管梗阻中的应用[J].临床泌尿外科杂志, 2016, 31 (11):1046-1049.