经皮肾造瘘序贯顺行性输尿管支架置入术治疗输尿管恶性梗阻  

Percutaneous Nephrostomy and Secondary Anterograde Ureteral Stent Placement in Malignant Ureteric Obstruction

作　　者：朱军[1] 徐晓茜[2] 雷开键[1] 贾钰铭[1] 陈尧勇 王强 黄勇[1] Zhu Jun;Xu Xiaoxi;Lei Kaijian(The Second People′s Hospital of Yibin,Yibin,Sichuan 644000;Outpatient Department of Yibin Municipal Center for Disease Control and Prevention,Yibin,Sichuan 644000,China)

机构地区：[1]宜宾市第二人民医院放射介入科,肿瘤科,四川宜宾644000 [2]宜宾市疾病预防控制中心门诊部,四川宜宾644000

出　　处：《四川医学》2018年第6期663-665,共3页Sichuan Medical Journal

摘　　要：目的评价采用经皮肾造瘘序贯顺行性输尿管支架置入术治疗输尿管恶性梗阻伴肾功能不全的可行性、安全性及疗效。方法 28例输尿管恶性梗阻患者,一期行经皮肾穿刺造瘘,待肾功能指标改善后二期行顺行性输尿管内支架置入术,回顾性讨论该方法的优缺点、输尿管支架置入成功率、术后并发症,超声和肾功能指标随访评价疗效。结果对28例患者顺利完成44个部位经皮肾造瘘术,术后2周内有26例患者血肌酐(Cr)和尿素氮(BUN)均恢复正常。1个病例术后出现顽固性血尿,成功行肾动脉栓塞止血治疗。26例患者共置入39根输尿管支架,其中15例为双侧置入,有2例单侧输尿管梗阻支架置入不成功。术后仅部分患者出现一过性血尿和腹痛。可随访的23例患者其3、6及12个月的支架通畅率分别为88.24%、56.00%和38.46%。结论经皮肾造瘘序贯顺行性输尿管支架置入术是治疗输尿管恶性梗阻伴肾功能不全的一种有效方法,该方法操作相对简单、安全,临床疗效确切。Objective To evaluate the feasibility,safety and efficacy of percutaneous nephrostomy and secondary anterograde ureteral stent placement for the treatment of malignant ureteral obstruction accompanied by renal insufficiency.Methods There were 28patients with malignant ureteral obstruction.,on whom the one-stage percutaneous nephrostomy was performed,and after the improvement of renal function index,second-stage anterograde ureteral stent placement was preformed,then the advantages and disadvantages of the method,the success rate of ureteral stent placement,postoperative complications were reviewed retrospectively,and ultrasound and renal function index were followed-up to evaluate the therapeutic effect.Results A total of 44 sites with percutaneous nephrostomy were successfully completed in 28 patients,and blood creatinine(Cr)and urea nitrogen(BUN)of 26 patients were recovered within 2 weeks after surgery.Intractable hematuria occurred after operation in one case,and it was successfully treated by renal artery embolization.Of the 26 patients,39 ureteral stents were implanted,15 of which were bilateral,and 2 patients with unilateral ureteral obstruction were unsuccessful.Only some of the patients had a transient hematuria and abdominal pain.In the 23 patients that could be followed-up,the stent patency rate within 3 months,6 months and 12 months were respectively 88.24%,56.00%and 38.46%.Conclusion Percutaneous nephrostomy and secondary anterograde ureteral stent placement is an effective method for treatment of malignant ureteral obstruction accompanied by renal insufficiency,which is relatively simple,safe and with exact therapeutic effect.

关 键 词：肾造瘘 输尿管 支架 恶性梗阻 

分 类 号：R691.2[医药卫生—泌尿科学]