介入治疗逆行D-J管置入失败的输尿管狭窄  

Interventional Treatment of Ureteral Stricture After Failed Retrograde D-J Tube Placement

作　　者：李超迪 刘娟芳[1] 张镐哲 闫肃 常琼方 张建好[1] LI Chaodi;LIU Juanfang;ZHANG Haozhe(The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Provinice 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院,450052

出　　处：《临床放射学杂志》2024年第7期1206-1209,共4页Journal of Clinical Radiology

基　　金：河南省医学科技攻关计划项目(编号:SBGJ202002057)。

摘　　要：目的探讨介入治疗逆行D-J管置入失败的输尿管狭窄的可行性及临床效果。方法选取膀胱镜下逆行置入D-J管失败的输尿管狭窄患者36例为研究对象,应用介入方法操作,穿刺肾盂后行输尿管造影,导管导丝配合下顺行通过输尿管狭窄进入膀胱,异物抓捕器经尿道进入膀胱拉出导丝至尿道口外,经导丝逆行放置引流导管,远端成襻位于肾盂,近端推至膀胱内。观察术前术后肌酐水平、肾盂分离程度及肾小球滤过率的变化。结果36例患者经介入方法均成功置入引流导管,患者均表现为尿量增加、患侧腰背部酸痛改善。术后3天、3个月、6个月的超声检查对比分析,肾盂分离及肾小球滤过率较术前改善,差异有统计学意义(P<0.05);12例双侧输尿管狭窄患者术后3天、3个月、6个月肌酐较术前改善,差异有统计学意义(P<0.05),24例单侧输尿管狭窄患者术后3天、3个月、6个月肌酐较术前改善,差异无统计学意义(P>0.05)。结论对于膀胱镜下逆行置入D-J管失败的输尿管狭窄患者,经介入操作置入引流导管是一种创伤小、恢复快、疗效确切的方法。Objective To investigate the feasibility and clinical effect of interventional treatment for retrograde D-J tube implantation failure of ureteral stenosis.Methods Retrograde placement under cystoscope D-J tube failure of 36 patients with ureteral stricture as the research object,the application of interventional method,puncture renal pelvis ureter after angiography,pipe thread with anterograde through ureteral stricture into the bladder,foreign body capture device through the urethra into the bladder to pull out the thread to the urethral opening,the godet retrograde placement of drainage catheter,distal to climb is located in the renal pelvis,Push the proximal to the bladder.The changes of creatinine level,degree of renal pelvis and glomerular filtration rate were observed before and after operation.Results The drainage catheter was successfully placed in 36 patients by interventional method.All patients showed increased urine output and improvement of low back pain on the affected side.The improvement of renal pelvis separation and glomerular filtration rate by ultrasound 3 days,3 months and 6 months after operation was statistically significant compared with that before operation(P<0.05).The improvement of creatinine in 12 patients with bilateral ureteral stricture 3 days,3 months and 6 months after operation was statistically significant compared with that before operation(P<0.05).In 24 patients with unilateral ureteral stricture,there was no significant difference in creatinine improvement 3 days,3 months and 6 months after operation compared with that before operation(P>0.05).Conclusion For patients with ureteral stricture who failed retrograde placement of D-J tube under cystoscope,interventional operation is a minimally invasive,quick recovery and effective method.

关 键 词：输尿管狭窄 介入治疗 肾功能 肾盂分离 肾小球滤过率 

分 类 号：R699.4[医药卫生—泌尿科学]