输尿管狭窄伴息肉样增生性输尿管炎的诊治

The diagnosis and treatment of ureteral stricture accompanied with polypoid hyperplastic ureteritis

目的探讨输尿管狭窄伴息肉样增生性输尿管炎的诊断与治疗。方法回顾性分析6例输尿管狭窄伴息肉样增生性输尿管炎患者的临床资料。结果本组6例,输尿管镜检查见输尿管中、下段均存在管腔狭窄(长度平均3.3cm),狭窄段及其近端可见散在淡黄色或淡红色息肉形成。4例行输尿管镜下气囊或镜体扩张,术后予双"J"管引流和抗感染等治疗1月。2例因输尿管狭窄严重,无法行扩张置管,而改行切除输尿管狭窄段,后行输尿管端端吻合术。术后1年随访临床症状无复发,复查腹部平片+静脉尿路造影输尿管梗阻和肾积水表现消失。结论对于输尿管狭窄伴发输尿管炎者,输尿管镜检查是主要诊断手段,镜下气囊或镜体扩张、双"J"管引流联合抗感染是有效治疗措施。

Objective To explore the diagnosis and hyperplastic ureteritis. Methods The retrospective study was accompanied with polypoid hyperplastic ureteritis. Results treatment of ureteral stricture accompanied with polypoid carried out on the clinical data from 6 cases of ureteral stricture Ureteral stricture in the mid or at the distal of ureter was detected by ureteroscopy （mean length 3.3 cm） and scattered canary or erythroic polyps was formed at the stricture position and the proximal part. Ureteral strictures were dilated by balloon or ureteroscope in 4 cases, followed by double J stent placement and antibiotic therapy for 1 month. Segmental resection of ureteral stricture and ureteroureterostomy was perfomed on 2 cases because of failure to dilate and place double J stent in ureteroscopy for the serious stricture. Follow-up for one year found no recurrence and KUB＋IVP showed that ureteral obstruction and hydronephrosis had disappeared. Conclusion It is suggested that ureteroscopy is a key diagnosis method for ureteral stricture accompanied with ureteritis. It is an efficient management to combine ureteral dilation with balloon or ureteroscope, followed by double J stent placement, and antibiotic therapy simultaneously.