Efficacy of double J stent indwelling strategy after balloon dilatation on secondary ureteral stricture
-
摘要: 目的 评价输尿管镜直视下球囊扩张术中不同双J管留置策略对治疗继发性输尿管狭窄的近期效果。方法 选取2020年1月—2021年12月南京医科大学第一附属医院就诊的92例继发性输尿管狭窄患者，根据治疗方法将其分为球囊扩张+双支架管组(F21球囊，30个大气压，3 min，留置2根F6支架管)、球囊扩张+单支架管组(F21球囊，30个大气压，3 min，留置1根F6支架管)、留置支架管组(仅留置1根F6支架管)，对于扩张组中严重狭窄患者，采用钬激光光纤物理切割出通道后再行球囊扩张，评价输尿管镜直视下球囊扩张治疗继发性输尿管狭窄的效果。结果 共纳入92例患者，球囊扩张+双支架管组38例，有效率84.21%；球囊扩张+单支架管组33例，有效率63.64%；留置支架管组21例，有效率28.57%；3组患者术后并发症发生率无明显差异，且均无严重术后并发症；其中球囊扩张组中单纯球囊扩张组(56例)与球囊扩张+光纤物理切割组(15例)有效率相当，且术后并发症发生率无显著差异。结论 输尿管镜直视下球囊扩张术结合光纤物理切割是治疗继发性输尿管狭窄的有效方式。在手术过程中，同等扩张时间、扩张气压及扩张直径下，留置2根F6双J管，相较于留置单根F6双J管，可提高治疗的有效率。Abstract: Objective To evaluate the efficacy of different double J stent indwelling strategies after ureteroscopic balloon dilatation in the treatment of secondary ureteral stricture.Methods From January 2020 to December 2021, 92 patients with secondary ureteral stricture in the First Affiliated Hospital of Nanjing Medical University were selected and divided into three group: balloon dilatation+2 stents group (F21 balloon, 30 atmospheres, 3 minutes, 2 F6 double J stent), balloon dilatation+1 stent group (F21 balloon, 30 atmospheres, 3 minutes, 1 F6 stent), and only stent group (only 1 F6 stent). In the dilatation group, patients with severe ureteral stricture were treated with balloon dilatation plus physical incision by holmium laser fiber. The efficacy of balloon dilatation under ureteroscopy on secondary ureteral stricture was evaluated.Results A total of 92 patients were included. Thirty-eight patients were in the balloon dilatation + 2 stents group, and the effective rate was 84.21%. Thirty-three patients were in balloon dilatation+1 stent group, and the effective rate was 63.64%. Twenty-one patients were in the only stent group, and the effective rate was 28.57%. There was no significant difference in the incidence of postoperative complications among the three groups. Additionally, in the balloon dilatation group, the effective rate was the same in the only balloon dilatation group (56 patients) and the balloon dilatation plus fiber physical incision group (15 patients), and there was no significant difference in the incidence of postoperative complications.Conclusion Ureteroscopic balloon dilatation plus fiber physical incision is an effective method for the treatment of secondary ureteral stricture. During the operation, under the same expansion time, pressure, diameter, indwelling two F6 double J stents can improve the treatment efficiency compared with single F6 double J stent.
-
Key words:
- balloon dilatation /
- ureteral stricture /
- double J stent /
- endoscopy
-
-
表 1 3组患者临床一般资料
例(%)，X±S 项目 球囊扩张+双支架组
(38例)球囊扩张+单支架组
(33例)对照组
(21例)χ2/F值 P值 年龄/岁 46.40±15.24 44.20±12.01 45.80±13.37 0.035 0.966 性别 0.034 1.000 男 19(50.00) 17(51.52) 11(52.38) 女 19(50.00) 16(48.48) 10(47.62) 侧别 0.382 0.863 左 18(47.37) 18(54.55) 11(52.38) 右 20(52.63) 15(45.45) 10(47.62) 位置 0.095 1.000 肾盂输尿管交界处 11(28.95) 9(27.27) 6(28.57) 上段 11(28.95) 10(30.30) 6(28.57) 中段 4(10.53) 3(9.09) 2(9.52) 下段 12(31.58) 11(33.33) 7(33.33) 狭窄程度 0.482 0.841 部分 8(21.05) 7(21.21) 3(14.29) 严重 30(78.95) 26(78.79) 18(85.71) 血肌酐/(μmol·L-1) 106.40±25.52 115.60±25.38 116.20±23.23 0.247 0.785 肾积水/mm 29.00±10.04 31.60±9.73 32.00±8.27 0.151 0.862 
下载: 导出CSV
表 2 3组手术相关资料及术后并发症
例(%)，X±S 项目 球囊扩张+双支架组
(38例)球囊扩张+单支架组
(33例)对照组
(21例)χ2/F值 P值 手术时间/min 31.80±8.50 30.15±9.19 18.60±4.97 4.235 0.041 恢复饮食时间/d 1.03±0.14 1.07±0.15 1.10±0.20 0.186 0.832 术后住院时间/d 2.16±0.27 2.12±0.19 1.92±0.22 1.576 0.247 术后并发症 腹胀 2(5.26) 1(3.03) 1(4.76) 尿外渗 0(0) 0(0) 0(0) 发热 2(5.26) 2(6.06) 1(4.76) 腰痛 2(5.26) 3(9.09) 1(4.76) LUTS 2(5.26) 1(3.03) 1(4.76) 输尿管瘘 0(0) 0(0) 0(0) 输尿管撕脱 0(0) 0(0) 0(0) 合计 8(21.05) 7(21.21) 4(19.48) 0.098 1.000
下载: 导出CSV
表 3 3组患者手术有效率比较
例(%) 疗效 球囊扩张+双支架组
(38例)球囊扩张+单支架组
(33例)对照组
(21例)χ2值 P值 有效 32(84.21) 21(63.64) 5(23.81) 20.975 < 0.001 无效 6(15.79) 12(36.36) 16(76.19)
下载: 导出CSV
表 4 部分狭窄组与严重狭窄组的手术有效率及手术并发症比较
例(%) 项目 部分狭窄组
(56例)严重狭窄组
(15例)χ2值 P值 疗效 0.419 0.744 有效 42(75.00) 10(66.66) 无效 14(25.00) 5(33.33) 术后并发症 0.014 1.000 腹胀 2(3.57) 1(6.67) 尿外渗 0(0) 0(0) 发热 3(5.36) 1(6.67) 腰痛 4(7.14) 1(6.67) LUTS 3(5.36) 0(0) 输尿管瘘 0(0) 0(0) 输尿管撕脱 0(0) 0(0)
下载: 导出CSV
-
[1] Corrales M, Doizi S, Barghouthy Y, et al. A systematic review of long-duration stents for ureteral stricture: which one to choose?[J]. World J Urol, 2021, 39(9): 3197-3205. doi: 10.1007/s00345-020-03544-x
[2] Li X, Qiao J, Xiong S, et al. The surgical outcomes of reconstruction for the treatment of ureteral stricture after holmium laser lithotripsy: The comprehensive experience[J]. Asian J Surg, 2022, 45(12): 2713-2718. doi: 10.1016/j.asjsur.2022.03.018
[3] 廖文彪, 杨嗣星, 宋超, 等. 输尿管镜钬激光碎石术后输尿管狭窄的处理方法5年单中心回顾性研究[J]. 中华泌尿外科杂志, 2021, 42(12): 910-914.
[4] Buffi NM, Lughezzani G, Hurle R, et al. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions[J]. Eur Urol, 2017, 71(6): 945-951. doi: 10.1016/j.eururo.2016.07.022
[5] Lucas JW, Ghiraldi E, Ellis J, et al. Endoscopic Management of Ureteral Strictures: an Update[J]. Curr Urol Rep, 2018, 19(4): 24. doi: 10.1007/s11934-018-0773-4
[6] 刘俊炜, 杨嗣星. 输尿管结石术后发生输尿管狭窄的机制及相关危险因素分析[J]. 临床泌尿外科杂志, 2022, 37(6): 478-482. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2022.06.016
[7] 秦鹏飞, 黄挺, 方立, 程跃. 激光腔内碎石术后并发输尿管狭窄的预防研究进展[J]. 临床泌尿外科杂志, 2021, 36(8): 663-667. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW202108015.htm
[8] Tyritzis SI, Wiklund NP. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review[J]. J Endourol, 2015, 29(2): 124-136. doi: 10.1089/end.2014.0522
[9] Kallidonis P, Ntasiotis P, Knoll T, et al. Minimally Invasive Surgical Ureterolithotomy Versus Ureteroscopic Lithotripsy for Large Ureteric Stones: A Systematic Review and Meta-analysis of the Literature[J]. Eur Urol Focus, 2017, 3(6): 554-566. doi: 10.1016/j.euf.2017.04.006
[10] May PC, Hsi RS, Tran H, et al. The Morbidity of Ureteral Strictures in Patients with Prior Ureteroscopic Stone Surgery: Multi-Institutional Outcomes[J]. J Endourol, 2018, 32(4): 309-314. doi: 10.1089/end.2017.0657
[11] Lu H, Zheng C, Liang B, et al. Analysis of long-term effect of ureteral balloon dilatation combined with internal and external drainage tube in the treatment of benign ureteral stricture[J]. BMC Urol, 2022, 22(1): 4. doi: 10.1186/s12894-022-00952-6
[12] 刘任平, 许婷, 徐苓傈. 三种不同术式治疗输尿管狭窄的疗效及安全性分析[J]. 微创泌尿外科杂志, 2019, 8(2): 88-92. https://www.cnki.com.cn/Article/CJFDTOTAL-WCMN201902006.htm
[13] Lu C, Zhang W, Peng Y, et al. Endoscopic Balloon Dilatation in the Treatment of Benign Ureteral Strictures: A Meta-Analysis and Systematic Review[J]. J Endourol, 2019, 33(4): 255-262. doi: 10.1089/end.2018.0797
[14] Markić D, Valencić M, Maricić A, et al. Retrograde balloon dilatation as a minimally invasive treatment for ureteral stricture[J]. Lijec Vjesn, 2012, 134(9-10): 281-285.
[15] 陈松, 唐宇哲, 付猛, 等. 良性输尿管狭窄的治疗: 90例单中心回顾分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(4), 313-316.
[16] Ibrahim HM, Mohyelden K, Abdel-Bary A, et al. Single Versus Double Ureteral Stent Placement After Laser Endoureterotomy for the Management of Benign Ureteral Strictures: A Randomized Clinical Trial[J]. J Endourol, 2015, 29(10): 1204-1209. doi: 10.1089/end.2015.0445
[17] 刘永达, 袁坚. 输尿管镜术后双J管引流无效原因分析[J]. 中华泌尿外科杂志, 2004, 25(10), 694-696. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHMN200410020.htm
[18] Mohyelden K, Hussein HA, El Helaly HA, et al. Long-Term Outcomes of Two Ipsilateral vs Single Double-J Stent After Laser Endoureterotomy for Bilharzial Ureteral Strictures[J]. J Endourol, 2021, 35(6): 775-780.
[19] 刘杰, 薛江辉, 冉光勇, 等. 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[J]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(4): 251-254. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHQJ201904009.htm
[20] Han PK, Rohan M, Mohd Adam B. The short-term outcome of laser endoureterotomy for ureteric stricture[J]. Med J Malaysia, 2013, 68(3): 222-226.
[21] Gnessin E, Yossepowitch O, Holland R, et al. Holmium laser endoureterotomy for benign ureteral stricture: a single center experience[J]. J Urol, 2009, 182(6): 2775-2779.
[22] 王凯, 陈林, 何平林, 等. 输尿管狭窄的微创治疗进展[J]. 现代泌尿外科杂志, 2019, 24(5): 413-416, 420. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWK201905029.htm
-
图(1)
表(4)
计量
- 文章访问数: 1165
- PDF下载数: 231
- 施引文献: 0