Allium自膨胀覆膜支架治疗复杂性输尿管狭窄的远期安全性及有效性评价  

Long-term safety and efficacy of Allium self-expanding covered stent in treatment of complex ureteral stricture

作　　者：李茂[1] 张国庆[1] 梁思敏[1] 李杰[1] Li Mao;Zhang Guoqing;Liang Simin;Li Jie(Department of Urology,The First Affiliated Hospital of Chongqing Medical University)

机构地区：[1]重庆医科大学附属第一医院泌尿外科,重庆400016

出　　处：《重庆医科大学学报》2024年第6期765-770,共6页Journal of Chongqing Medical University

摘　　要：目的:评估Allium自膨胀覆膜支架治疗复杂性输尿管狭窄的长期疗效和安全性。方法:回顾性分析2020年4月至2021年12月,在重庆医科大学第一附属医院泌尿外科置入Allium自膨胀覆膜支架的输尿管狭窄患者临床资料及长期随访结果。对符合正态分布的关键性指标行配对样本T检验,对不符合正态分布指标行相关样本非参数检验。结果:通过排除标准严格选择后,本研究共纳入22例通过内镜下Allium自膨胀覆膜支架置入的输尿管狭窄患者。平均年龄为(48.3±10.6)岁,中位随访时间为36.5个月。手术时间为86(35~270)min,围术期没有严重并发症发生。随访结果显示,有17例(77.3%)覆膜支架始终保持在位且通畅,其中16例随访终点时肾积水消失,1例由术前重度积水改善为轻度积水。1例患者因肾积水无法缓解选择拔出支架后行机器人输尿管重建手术。4例患者因并发结石取出支架,其中1例患者取出支架后无肾积水,1例患者积水减轻,其余2例患者仍为重度积水,但尿液排泄通畅无腰痛症状。随访期间患者未见明显手术并发症及严重支架管相关症状。患者的术前平均血肌酐浓度为(103.6±31.1)μmol/L,终末随访时血肌酐浓度下降为(102.2±27.7)μmol/L,差异无统计学意义(P=0.942)。最大肾积水宽度术前为(5.9±2.1)cm,术后为(1.7±1.2)cm,差异有统计学意义(P=0.000)。与术后相比,终末最大肾积水宽度为(0.35±0.25)cm,差异有统计学意义(P=0.001)。结论:Allium自膨胀覆膜支架管在复杂输尿管狭窄治疗的长期观察中能有效改善患者肾积水。支架管症状、疼痛、感染等并发症保持较低的发生率,并且可长期留置,减少患者更换支架的频率。Objective:To investigate the long-term safety and efficacy of Allium self-expanding covered stent in the treatment of complex ureteral stricture.Methods:A retrospective analysis was performed for the clinical data and long-term follow-up results of 22 patients with ureteral stricture who underwent Allium self-expanding covered stent implantation in The First Affiliated Hospital of Chongqing Medical University from April 2020 to December 2021.The paired samples t-test was used for normally distributed key indicators,and the non-parametric test of related samples was used for non-normally distributed key indicators.Results:A total of 22 patients with ureteral stricture who underwent Allium self-expanding covered stent implantation were included based on strict exclusion criteria,with a mean age of(48.3±10.6)years and a median follow-up time of 36.5 months.The time of operation was 86(35-270)minutes,and there were no serious complications in the perioperative period.Follow-up results showed that the covered stent remained in place and unobstructed in 17 patients(77.3%),among whom 16 patients showed disappearance of hydronephrosis at the end of follow-up and 1 patient was improved from severe hydronephrosis to mild hydronephrosis.One patient underwent robotic ureteral re-construction after removal the stent due to unrelieved hydronephrosis.The stent was removed in 4 patients due to the complication of calculus,among whom 1 had no hydronephrosis after stent removal,1 had alleviation of hydronephrosis,and the other two patients still had severe hydronephrosis and unobstructed urine excretion without the symptom of lumbago.No serious surgical complications or seri-ous stent-related symptoms were observed during follow-up.The mean concentration of serum creatinine was(103.6±31.1)μmol/L before surgery,which decreased to(102.2±27.7)μmol/L at the end of follow-up(P=0.942).The maximum width of hydronephrosis was(5.9±2.1)cm before surgery and(1.7±1.2)cm after surgery(P=0.000).The maximum width of hydronephrosis was(0.3

关 键 词：输尿管狭窄 内镜治疗 Allium覆膜支架 

分 类 号：R737.14[医药卫生—肿瘤]