经皮腔内穿刺复通治疗肾盂输尿管连接部梗阻

Percutaneous endopuncturation in the treatment of ureteropelvic junction obstruction

目的:探讨肾盂切开取石术后肾盂输尿管连接部梗阻(UPJO)的有效治疗方法。方法:对23例行肾盂切开取石术后出现肾盂输尿管连接部梗阻的患者,通过经皮肾造瘘在床边C臂X光机监视下行腔内穿刺复通肾盂输尿管连接部,扩张穿刺通道后留置形状记忆合金网状金属支架,术后服用泼尼松片,3个月后复查肾造瘘管造影,了解复通情况。结果:16例患者复通效果良好,其中术前患肾GFR>30ml/min组的成功率为88%(15/17),术前患肾GFR<30ml/min组的成功率为16.7%(1/6),顺利拔除肾造瘘管。结论:通过经皮肾造瘘行腔内穿刺复通治疗肾盂输尿管连接部闭锁是一种安全有效的方法。

Objective ： To report our experience in treating ureteropelvic junction obstruction resulted from pyelolithotomy. Methods：We retrospectively review the clinical data of 23 patients with ureteropelvic junction obstruction resulted from pyelolithotomy who underwent percutaneous nephrostomy. Endopuncturation was performed under the observation of C-arm X-ray apparatus and recanalized the obstructed segment. The recanalized segment was dilated,then a metallic stent was inserted. All patients were given prednisone postoperatively and underwent antegrade nephrostogram 3 months later to examine the situation of recanalization, Results：Totally 16 patients were successfully recanalized. The achievement ratio was 88% （15/17） in patients whose GFR of the suffer kidney was〉30 ml/min compare with 16.7%（1/6） in patients whose GFR of the suffer kidney was〈30 ml/min preoperatively, Conclusions： Ureteropelvic junction obstruction can be successfully treated by pereutaneous endopuncturation, this technique is safe,effective and less invasive.