金属支架治疗上尿路闭锁的长期随访结果(26例报告)

Long-term results of permanent metallic stent implantation in the treatment of upper urinary tract atresia

目的评价金属支架植入治疗上尿路闭锁的长期疗效。方法 1995年10月～2009年12月,采用金属支架永久植入治疗上尿路闭锁患者26例,其中肾盂输尿管连接部闭锁17例,肾下盏输尿管吻合口闭锁3例,输尿管上段闭锁5例,输尿管膀胱吻合口闭锁1例。闭锁长度1.0～4.8cm。采用影像学方法进行定期随访,必要时行输尿管镜检查。结果 26例术后随访1～16年,平均94个月。放置金属支架后上尿路引流通畅14例,5例因严重瘢痕压迫须重叠植入金属支架,3例须长期放置双J管辅助引流,2例因肾功能进行性恶化而行肾切除,2例因肾积脓感染无法控制而取金属支架。22例最终留置金属支架患者中,肾功能保持良好者15例,肾功能中度损害6例,1例患肾并发肾盂移行上皮癌死亡。3例分别于置管后4、6及6个月内反复出现金属支架内肉眼组织生长,行钬激光汽化或输尿管镜电切镜切除肉芽组织;3例患者于置管术后28、32及84个月发现金属支架突出肾盂段结石,行经皮肾镜术或输尿管镜术取出。结论金属支架治疗上尿路闭锁安全、有效,长期随访结果满意。金属支架引流不畅的原因包括金属支架支撑力不足、金属支架内肉芽组织生长和结石形成。

[ Objective ] To evaluate the long-term results of permanent metallic stent for the treatment of upper urinary tract atresia. [Methods ] From October 1995 to December 2009, permanent metallic stents were implanted in 26 patients, including 17 cases of ureteropelvic junction atresia, 3 cases of ureterocalieostomic atresia, 5 cases of upper ureter atresia and 1 of ureterovesicostomotic atresia. Regular imaging studies were performed during follow-up and ureteroscopy was done when needed. [Results] All the 26 patients had follow-up for 1-16 years with a mean of 94 months. Upper urinary tract patency was achieved in 14 cases. Implanted repeatedly metallic stents in 5 cases and assisted patency with a double-J stent in 3 cases. In 2 cases, the kidneys had to be removed because of pro- gressive malfunction; and in 2 cases, the metallic stents had to be extracted because of uncontrollable pyonephrosis. Of 22 cases of retained metallic stents eventually, renal function was good in 15 cases, moderately impaired renal function in 6 cases, one died from transitional cell carcinoma of renal pelvis. Granulation tissue growth was found within the stents in 3 cases at 4, 6, and 6 months, respectively, after stenting; holmium laser vaporization of the gran-ulation tissue was performed. Three cases had calculi at the proximal end of the stent at 28, 32,84 months, respec- tively, after implantation. The calculi were taken out via micro-invasive percutaneous nephrolithotomy or ureteroscopy. [ Conclusions ] Implantation of metallic stent for upper urinary tract atresia is safe and effective with satisfactory long-term outcome in selected patients. The causes of poor drainage of metallic stent were insufficient expansive force, granulation tissue growth and calculi formation within the metallic stent.