球囊扩张术后留置双J管策略对继发性输尿管狭窄的近期疗效分析  

Efficacy of double J stent indwelling strategy after balloon dilatation on secondary ureteral stricture

作　　者：韩鹏[1] 鲁佩[1] 张炜[1] 孟祥虎 梁超[1] 张杰秀[1] 王增军[1] 宋日进[1] HAN Peng;LU Pei;ZHANG Wei;MENG Xianghu;LIANG Chao;ZHANG Jiexiu;WANG Zengjun;SONG Rijin(Department of Urology,First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,南京210029

出　　处：《临床泌尿外科杂志》2023年第1期33-38,共6页Journal of Clinical Urology

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。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.

关 键 词：球囊扩张 输尿管狭窄 双J管 腔内治疗 

分 类 号：R693[医药卫生—泌尿科学]