移植肾输尿管狭窄的腔内治疗（附 43 例报告）

Clinical analysis of endovascular treatment for ureteral stricture of transplanted kidney (43 cases)

摘要:

摘要：目的??探讨经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术在腔内治疗移植肾输尿管狭窄中的安全性及有效性。方法 回顾性分析2007年5月－2017年12月于该院治疗的43例移植肾输尿管狭窄患者的临床资料。平均年龄35.7岁，输尿管膀胱吻合口狭窄平均长度0.75?cm，输尿管行程段狭窄平均长度0.70 cm。术中采用经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术对移植肾输尿管狭窄或闭锁段行电刀内切开和球囊扩张术，术后留置输尿管内支架管或金属支架。结果 43例移植肾输尿管狭窄患者中，经尿道逆行输尿管镜治疗组20例，联合经皮肾穿刺顺行输尿管镜技术治疗23例，平均手术时间为（53.3±10.5）min，30例经腔内治疗痊愈，其中一期治疗成功13例，17例行2或3次腔内球囊扩张后治愈；13例反复狭窄复发予以留置镍钛形状记忆合金支架，其中5例留置新型金属覆膜支架，术后随访时间为3～36个月，实验室复查血清肌酐（Scr）（143.4±28.0）μmol/L。结论 采用经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术等腔内治疗途径，处理移植肾输尿管狭窄是安全、有效及可靠的。

Abstract:

Abstract: Objective?To investigate the safety and efficacy of minimally invasive percutaneous antegrade and transurethral retrograde ureteroscopy in treatment of transplanted kidney ureteral stricture.?Methods?The clinical data of 43 patients with ureteral stricture from May 2007 to December 2017 were retrospectively analyzed. Minimally invasive percutaneous antegrade and ureteral retrograde ureter were used. Endoscopic treatment such as mirror technique, electrosurgical incision or balloon dilatation in the ureteral stricture or atresia of the transplanted kidney, postoperative placement of NiTi shape memory alloy stent or ureteral stent tube, regular review and evaluation of renal function variety.?Results?Of the 43 patients with renal ureteral stricture, 20 underwent transurethral retrograde ureteroscopy, 23 underwent minimally invasive percutaneous antegrade combine with transurethral retrograde ureteroscopy. The operation time was average (53.3?±?10.5) min. There were 17 patients underwent 2 to 3 times intraluminal balloon dilatation, 13 cases of NiTi shape memory alloy stent, 5 cases of new type NiTi memory stent (Allium Stents). After 3 to 36 months of follow-up, The Scr was average (143.4?±?28.0)?μmol/L.?Conclusion?Minimally invasive percutaneous antegrade and transurethral retrograde ureteroscopy for the treatment of ureteral stricture is safe, effective and reliable, especially for stenosis and obstruction repeatedly.