-
摘要: 目的 总结输尿管镜腔内治疗输尿管狭窄的临床疗效。方法 回顾性分析65例应用输尿管镜腔内技术治疗输尿管狭窄患者的临床资料。男34例，女31例；年龄18~73岁，平均42岁。其中狭窄段长度 < 0.5 cm者13例，0.5~1.5 cm者40例，1.6~2.0 cm者12例。狭窄段位于肾盂输尿管连接部(UPJ)者6例，输尿管上段者23例，中段者14例，下段者22例。1例经腔内球囊扩张联合Allium覆膜金属输尿管网状支架植入术，3例经尿道输尿管镜球囊扩张联合腔内钬激光内切开术，13例行钬激光内切开术，14例行导管扩张术，16例行输尿管镜镜体扩张术，18例行球囊扩张术。结果 65例患者中，63例成功行腔内治疗，2例因腔内治疗失败，更改手术方式，1例行输尿管狭窄段切除+端端吻合术，1例行腹腔镜下输尿管狭窄段切除+端端吻合术。术后1年获随访57例，43例(75.4%)一次手术治愈；14例(24.6%)狭窄复发，其中1例行膀胱肌瓣输尿管成形术，2例行腹腔镜下输尿管狭窄段切除端-端吻合术，2例行输尿管膀胱再植术，9例行再次腔内治疗。结论 输尿管镜腔内治疗输尿管狭窄并发症少、恢复快，是一种安全、有效的微创治疗技术。Abstract: Objective To investigate the efficacy of ureteroscopy for the treatment of ureteral stricture.Methods The clinical data of 65 patients with ureteral stricture treated by ureteroscopy were analyzed retrospectively. There were 34 males and 31 females. The age ranged from 18 to 73 years, with an average of 42 years. The stenosis length was less than 0.5 cm in 13 cases, 0.5 cm to 1.5 cm in 40 cases, and 1.6 cm to 2.0 cm in 12 cases. The stricture was located at the ureteropelvic junction (UPJ) in 6 cases, at the upper ureter in 23 cases, at the middle ureter in 14 cases, and at the lower ureter in 22 cases. Transurethral ureteroscopic balloon dilatation combined with implantation of Allium covered metal ureteral mesh stent was performed in 1 case, transurethral ureteroscopic balloon dilatation combined with endoluminal holmium laser incision in 3 cases, endoluminal holmium laser incision in 13 cases, catheter dilatation in 14 cases, ureteroscopic dilatation in 16 cases and balloon dilatation in 18 cases.Results Among the 65 cases, 63 cases were successfully treated by endoureterotomy, 2 cases were not. One case was treated by ureterostenosis resection and end-to-end anastomosis, and the other was treated by laparoscopic ureterostenosis resection and end-to-end anastomosis. Fifty-seven cases were followed up for 1 year after operation. Forty-three cases (75.4%) were cured by one operation, while other 14 cases (24.6%) had stenosis recurrence. Among the recurrence patients, 1 case underwent bladder muscle flap ureteroplasty, and 2 cases underwent laparoscopic resection of ureteral stenosis and end-to-end anastomosis, 2 cases of ureterobladder reimplantation, 9 cases of endourologic surgery again.Conclusion Endourologic management of ureteral stricture is a safe, effective and minimally invasive method with lower complication rate and fast recovery.
-
Key words:
- ureteroscopy /
- ureteral stricture /
- dilatation /
- endoureterotomy
-
-
[1] 黄慧宁, 孙毅海. 经尿道球囊扩张术治疗输尿管狭窄的临床疗效及影响因素分析[J]. 临床泌尿外科杂志, 2021, 36(5)394-397. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW202105013.htm
[2] Gao X, Chen J, Wang W, et al. Step-by-step technique for the endoscopic treatment of ureteric stricture[J]. BJU Int, 2021, 128(6): 692-696. doi: 10.1111/bju.15558
[3] Ključevšek T, Pirnovar V, Ključevšek D. Percutaneous nephrostomy in the neonatal period: Indications, complications, and outcome: A single centre experience[J]. Cardiovasc Intervent Radiol, 2020, 43(9): 1323-1328. doi: 10.1007/s00270-020-02528-z
[4] 高宇, 王保军, 徐衍盛, 等. ALLIUM覆膜输尿管支架治疗输尿管狭窄7例报告[J]. 微创泌尿外科杂志, 2020, 9(5): 289-293. https://www.cnki.com.cn/Article/CJFDTOTAL-WCMN202005002.htm
[5] Hu J, Lai C, Gao M, et al. A nomogram to predict stricture-free survival in patients with ureteral stricture after balloon dilation[J]. BMC Urol, 2021, 21(1): 129. doi: 10.1186/s12894-021-00896-3
[6] 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
[7] Gao W, Xing T, Ou T. The resonance and the allium ureteral stents in the treatment of non-malignant refractory ureterostenosis[J]. BMC Urol, 2021, 21(1): 53. doi: 10.1186/s12894-021-00815-6
[8] Avitan O, Bahouth Z, Shprits S, et al. Allium ureteral stent as a treatment for ureteral stricture: Results and concerns[J]. Urol Int, 2022, 106(5): 482-486. doi: 10.1159/000522174
[9] 王明瑞, 胡浩, 王起, 等. Allium覆膜金属输尿管支架长期留置治疗放疗后输尿管狭窄的有效性和安全性[J]. 中华泌尿外科杂志, 2020, 41(12): 921-926. doi: 10.3760/cma.j.cn112330-20200623-00488
[10] 石兵, 赵凡, 朱建, 等. Allium覆膜金属输尿管支架治疗输尿管狭窄的疗效分析[J]. 中国微创外科杂志, 2022, 22(5): 407-411. . https://www.cnki.com.cn/Article/CJFDTOTAL-ZWWK202205008.htm
[11] Gao X, Song T, Peng L, et al. Self-expanding metal ureteral stent for ureteral stricture: Experience of a large-scale prospective study from a high-volume center-cross-sectional study[J]. Int J Surg, 2021, 95: 106161. doi: 10.1016/j.ijsu.2021.106161
[12] 张春龙, 王明瑞, 王起, 等. 覆膜金属输尿管支架维持性治疗输尿管镜碎石术后难治性输尿管狭窄的远期疗效评价[J]. 北京大学学报(医学版), 2022, 54(4): 674-679. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB202204015.htm
[13] Gao X, Chen J, Jian Z, et al. Initial experience of self-expanding metal ureteral stent in recurrent ureteral stricture after ureteroplasty[J]. Front Surg, 2021, 8: 765810. doi: 10.3389/fsurg.2021.765810
[14] 赵海波, 徐桂彬, 李逊, 等. 覆膜金属支架在移植肾输尿管狭窄中的应用[J]. 中国微创外科杂志, 2020, 20(7): 631-634. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWWK202007015.htm
[15] 董文敏, 王明瑞, 胡浩, 等. Allium覆膜金属输尿管支架长期留置治疗输尿管-回肠吻合口狭窄的初期临床经验及随访结果[J]. 北京大学学报(医学版), 2020, 52(4): 637-641. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB202004008.htm
[16] 蔡巍, 缪勋忠. 经尿道输尿管镜球囊扩张与腔内钬激光内切开术治疗输尿管狭窄的临床疗效分析[J]. 实用医院临床杂志, 2020, 17(2): 230-233. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC202002068.htm
[17] 杨嗣星, 吴旭, 廖文彪, 等. 输尿管软镜下钬激光内切开引流术治疗肾囊性疾病的安全性及疗效[J]. 中华泌尿外科杂志, 2016, 37(1): 17-20. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201706046.htm
[18] Gnessin E, Yossepowitch O, Holland R, et al. Holmium laser endoureterotomy for benign ureteral strictuer: a single center experience[J]. Urology, 2009, 182(6): 2775-2779.
[19] 徐涛, 唐鑫伟, 胡浩. 输尿管狭窄的内镜治疗: 现状与未来[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(3): 177-181.
[20] 陈志华, 帅强. 输尿管导管联合输尿管镜在输尿管狭窄中的临床应用[J]. 中国医药科学, 2020, 10(17): 220-223. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX202017084.htm
[21] 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
[22] Lucas JW, Ghiraldi E, Ellis J, et al. Endoscopic management of ureteral strictures: An update[J]. CurrUrol Rep, 2018, 19(4): 24.
[23] 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.
[24] 惠强, 王福利, 秦荣良, 等. 球囊扩张术治疗继发性输尿管狭窄疗效分析[J]. 现代泌尿外科杂志, 2020, 25(3): 225-229. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWK202003007.htm
[25] 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.
[26] 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.
[27] 袁彪, 蒋宏毅. 输尿管镜下球囊扩张术与腹腔镜下输尿管成形术治疗良性输尿管狭窄的疗效比较[J]. 中华实用诊断与治疗杂志, 2020, 34(9): 947-950. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202009022.htm
[28] 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
[29] 郑春林, 张建军, 顾增华. 对比输尿管硬镜扩张后留置单根和双重双J管对复发性良性输尿管狭窄的疗效[J]. 名医, 2020, 11(3): 96, 99. https://www.cnki.com.cn/Article/CJFDTOTAL-MGYI202003086.htm
[30] 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.
[31] 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/OL]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(4): 251-254.
[32] 秦鹏飞, 黄挺, 方立, 等. 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
[33] Cheng W, Chiu YC, Fan YH, et al. Risks of forgotten double-J ureteric stents after ureterorenoscopic lithotripsy in Taiwan: a nationwide population-based study[J]. Sci Rep, 2020, 10(1): 20711.
-
计量
- 文章访问数: 1949
- PDF下载数: 1212
- 施引文献: 0
下载: