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  

Initial clinical experience and follow-up outcomes of treatment for ureteroileal anastomotic stricture with Allium coated metal ureteral stent

作　　者：董文敏 王明瑞 胡浩[1] 王起[1] 许克新[1] 徐涛[1] DONG Wen-min;WANG Ming-rui;HU Hao;WANG Qi;XU Ke-xin;XU Tao(Department of Urology,Peking University People’s Hospital,Beijing 100044,China;Department of Urology,People’s Hospital of Daxing District,Beijing 102600,China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044 [2]北京大兴区人民医院泌尿外科,北京102600

出　　处：《北京大学学报（医学版）》2020年第4期637-641,共5页Journal of Peking University:Health Sciences

基　　金：首都卫生发展科研专项(2020-2Z-40810)。

摘　　要：目的:总结长期留置Allium覆膜金属输尿管支架治疗根治性膀胱切除术后输尿管-回肠吻合口狭窄的初期临床经验及随访结果。方法:2018年9月至2019年9月在北京大学人民医院及北京市大兴区人民医院收治的8例(10侧)根治性膀胱切除术后输尿管-回肠吻合口狭窄患者,均采用Allium覆膜金属输尿管支架长期留置的方式进行输尿管狭窄的治疗。收集患者术前肾脏B超下肾盂宽度评估肾积水、手术前后肌酐及尿素氮、围手术期是否出现全身感染等手术相关和支架管相关并发症。出院后第1、3、6、12个月和之后每年复查血肌酐、尿素氮、超声下肾盂宽度,并通过尿路造影及泌尿系腹部X线检查观察支架位置和形态有无变化。回顾患者的围手术期资料和随访资料,观察统计患者的支架长期通畅率、并发症发生率、肾功能变化和肾积水情况。使用t检验或者秩和检验比较术前-末次随访的配对样本计量资料。结果:8例患者中有6例(7侧)输尿管-回肠流出道吻合口狭窄,2例(3侧)输尿管-回肠原位新膀胱吻合口狭窄。5例患者术前长期留置输尿管单J管,平均留置时间为(20.6±8.8)个月,平均更换频率为(3.6±1.3)个月/次。术前肾脏超声检查平均肾盂宽度为(26.5±9.1)mm。6例患者采用逆行置入方式成功留置Allium输尿管支架,2例患者采用双镜联合、顺逆行结合的方式成功置入支架;围手术期未出现手术相关并发症。患者平均随访9.8个月,所有患者在末次随访时均保持Allium支架和输尿管通畅,未进行过更换或移除;与术前相比,末次随访的平均肾盂宽度和平均尿素氮均显著降低[(26.5±9.1)mm vs.(13.4±2.5)mm,P=0.008;(11.6±2.3)mmol/L vs.(10.2±2.2)mmol/L,P=0.017)],而平均血肌酐和血红蛋白均无明显差异(P>0.05);未见输尿管再梗阻、支架管移位等支架管相关并发症。结论:Allium覆膜金属输尿管支架长期留置可用于治疗输尿�Objective:To summarize the initial clinical experience and follow-up results of the treatment for ureteroileal anastomotic stricture after radical cystectomy with Allium coated metal ureteral stent.Methods:From September 2018 to September 2019,8 patients with ureteroileal anastomotic stricture after radical cystectomy underwent Allium ureteral stent insertion in Peking University People’s Hospital and People’s Hospital of Daxing District.The preoperative renal pelvis width under ultrasound was collected to evaluate the postoperative hydronephrosis,creatinine and urea nitrogen(BUN)before and after surgery,perioperative infection,and stent-related complications.The serum creatinine and BUN,renal pelvis width under ultrasound,urography and abdominal plain film(KUB)were reviewed at the end of 1,3,and 6 months and annually postoperatively to observe the stent position and morphology.The long-term stent patency rate,complication rate,renal function and hydronephrosis were followed up and analyzed.The t-test or rank-sum test was used to compare the measurement data of the matched sample from the preoperative to the last follow-up.Results:In the study,6 cases(7 sides)were ureteral ileal conduit stricture,and 2 cases(3 sides)ureteral orthotopic neobladder stricture.Before surgery,5 patients underwent long-term indwelling of a single J ureteral stent,with an average indwelling time of(20.6±8.8)months and an average replacement frequency of(3.6±1.3)months/time.The mean width of renal pelvis was(26.5±9.1)mm on preoperative renal ultrasonography.Among them,6 patients were successfully indwelled with Allium coated metal ureteral stent by retrograde approach,and 2 patients by combination of double-endoscopy and ante-retrograde approach.No surgery-related complications during perioperative period were observed.The mean follow-up period was 9.8 months and Allium stent and ureter remained unobstructed in all the patients at the last follow-up without replacement or removal.Compared with preoperative data,the mean width of r

关 键 词：支架 吻合术 外科 输尿管梗阻 膀胱切除术 手术后并发症 

分 类 号：R693.2[医药卫生—泌尿科学]