输尿管镜球囊扩张术在良性输尿管狭窄中的应用

Application of ureteralscopic balloon dilation in the management of benign ureteral stricture

摘要:

目的 探讨输尿管镜球囊扩张术治疗良性输尿管狭窄（US）的临床效果。方法 回顾性分析输尿管镜下球囊扩张治疗18例US患者资料。男8例，女10例，年龄21～73岁，平均42岁。其中狭窄17例，闭锁1例。窄段长度<0.5 cm 10例，0.5～1.5 cm 6例，1.5 cm以上2例。狭窄段位于肾盂输尿管连接部3例，上段4例，中段4例，下段7例。结果 18例患者均在输尿管镜引导下找到正确通道，完成球囊扩张手术。留置单条7F输尿管内支架管10例，留置双条5F输尿管支架管8例。17例留置双J管6～12个月，1例患者留置双J管3个月。术后随访12～36个月，10例一次手术扩张有效。6例拔管半年后再次狭窄，行二次球囊扩张后有效。2例输尿管肾孟的接合处（UPJ）狭窄段过长，肾滤过功能均小于20 ml/min，术后1年复查，再次狭窄，行后腹腔镜下UPJ整形术后有效。结论 输尿管镜球囊扩张术是治疗US安全、有效的手术方法，可以作为US长度在1.5 cm以内的单侧肾功能轻-中度损害的US的首选方案。

Abstract:

Objective To evaluate ureteralscopic balloon dilation in treatment of benign ureteral stricture. Methods Clinical data of 18 cases were analyzed retrospectively, in which there are 8 males and 10 females. Their ages range from 21 to 73 years old and the mean age is 42 years old. 17 cases are ureteral stricture and 1 case is ureteral atresia. Among all of them, 10 cases with the length of ureteral stricture < 0.5 cm, 6 cases with the length of ureteral stricture < 0.5～1.5 cm and 2 cases with the length of ureteral stricture > 1.5 cm. On the aspect of stricture location, there are 3 cases with the stricture at the ureteropelvic junction level, 4 cases at the upper ureter level, 4 cases at the middle ureter level and 7 at the lower ureter level. The placement of single 7F internal ureteral stent was carried out on 10 cases. And double 5F internal ureteral stents were indwelt with the other 8 cases. The internal ureteral stent was left behind for 6～12 months in 17 cases while for 3 months in 1 case. Results The right way was found and stent implantation was completed successfully by balloon dilation in all the 18 cases through ureteroscope. All the patients were followed up for 12 to 36 months. During this period, 10 patients were cured by one time treatment, 6 patients received the second ureteralscopic balloon dilation due to re-stricture after taking out of the double J tube half year later. Stricture recurred in 2 patients after one year because of severe ureteropelvic junction obstruction (> 1.5 cm) and deteriorated kidney filtration (﹤20 ml/min). This two patients then received plastic surgery of UPJ by retroperitoneoscopy. Conclusions Ureteroscopy balloon dilatation is safe and effective for the treatment of ureteral stricture. It should be the principal alternative to the patients who have mild or moderate renal dysfunction and ureteral strictures being less than 1.5cm in length.