经皮肾通道输尿管软镜联合球囊扩张治疗复杂输尿管下段狭窄的效果观察  

Efficacy and safety of percutaneous renal access flexible ureteroscope plus balloon dilatation for patients with complex lower ureterostenosis

作　　者：李建华[1] 陈亮[2] 李建兴[2] 王晓峰[2] 

机构地区：[1]河南省商丘市第一人民医院泌尿外科,476100 [2]北京大学人民医院泌尿外科

出　　处：《中华医学杂志》2014年第46期3642-3645,共4页National Medical Journal of China

摘　　要：目的探讨经皮肾通道顺行输尿管软镜联合逆行球囊扩张治疗复杂输尿管下段狭窄的效果及安全性。方法2010年5月至2013年12月北京大学人民医院和河南省商丘市第一人民医院对78例复杂输尿管下段狭窄患者在超声引导下建立24F（3F：1mm）皮肾通道，置入纤维输尿管软镜，将斑马或超滑导丝放入膀胱内，再沿导丝逆行置入21F扩张球囊，维持26个大气压扩张狭窄段5min，再留置D-J管，术后观察其疗效及安全性。结果本组78例中，47例单侧输尿管狭窄和31例双侧输尿管狭窄患者均成功一期放置6F或7／12F加强型D-J管；3个月后拔除D-J管，72例患者肾积水逐浙减轻，随访时间为3～9个月（平均6个月），有效率达92．31％；另外6例患者在拔除输尿管内D—J管后1～3个月，肾积水未减轻或加重，并再次给予更换D-J管，且定期进行更换。结论经皮肾通道顺行输尿管软镜联合逆行球囊扩张治疗复杂输尿管下段狭窄，大多数可以逆转输尿管狭窄引起的感染、肾积水、肾功能不全等并发症，是一种安全有效的微创手术。Objective To explore the clinical efficacy and safety of percutaneous renal access anterograde flexible ureteroscope plus retrograde balloon dilation in the treatment of complex lower ureterostenosis. Methods Under ultrasonic guidance, renal calices were successfully punctured for 78 patients with lower ureterostenosis. Then the tract was gradually expanded to 24 F with a metal dilator. Afterward upper ureter was expanded with a flexible ureteroscope sheath. Upon an insertion of guide wire into bladder, a 21 F balloon dilator was retrogradely placed in the narrow segment and maintained for 5 min. Then a D-J stent was antegradely deployed along the guide wire. And the clinical efficacy and safety were followed up. Results 6 F or 7/12 F D-J stent was successfully placed in 47 patients with unilateral ureterostenosis and 31 with bilateral ureterostenosis. The D-J stent was removed after 3 months. During a follow-up period of 3 -9 months, 72 patients had gradually reduced hydronephrosis with an effective rate of 92. 31%. Hydronephrosis remained unchanged or aggravated in 6 patients requiring regular replacement of D-J stent. Conclusiotl For complex middle or lower ureterostenosis, percutaneous renal access anterograde flexible ureteroscope plus retrograde balloon dilatation can reverse infection, hydronephrosis, renal dysfunction and other complications. And it is safe, effective and mini-invasive.

关 键 词：输尿管梗阻 输尿管镜 经皮.肾通道 球囊扩张 

分 类 号：R699[医药卫生—泌尿科学]