经下入路介入法治疗输尿管狭窄(附25例报告)

Interventional Treatment of Ureteral Stricture via Lower Urinary TractA Report of 25 Cases

目的 探讨下入路介入法治疗输尿管狭窄的应用效果。材料与方法 2 5例经影像学确诊为输尿管狭窄并上尿路积水中 ,2 0例为输尿管取石术后狭窄 ,5例为不明原因非外压性狭窄。经膀胱镜将导丝送至输尿管狭窄以上 ,采用导丝导管交换及对比剂定位技术 ,在狭窄处行球囊扩张。结果 18例成功放置双J管行内引流 ,1例因输尿管上段高度纡曲狭窄置管失败 ,6例行单纯球囊扩张。术后分别观察 3、6、12个月及 1～ 5个月 ,复查B超、IVP显示肾积水程度减轻 ,肾功能改善。单纯球囊扩张者再狭窄程度在 40 %以下。双J管位置准确 ,无移位 ,16例顺利取出。结论 下入路介入法具有创伤小、操作简单、定位准确、并发症少 ,扩张和引流效果好等优点 ,是治疗输尿管狭窄的一种安全。

Objective To study the curative effect of ureteral stricture with interventional management via lower urinary tract.Materials and Methods Of 25 cases with ureteral stricture and upper hydroureterosis, 20 were due to ureterolithotomy and 5 nonexternal compressive stricture of unknown cause. Guidewire was inserted over ureteral stricture under endoscopic guidance. Through the wirecatheter exchange technique, the balloon catheter was placed at stricture site and dilatation of the stricture was performed.Results Balloon catheter dilatation was performed in 6 cases. DoubleJ ureteral stent was successfully placed in 18 cases, and failure to success in 1 case due to tortuous ureter. Bultrasound and IVP exams were done at the 3, 6, 12 months, and 1～5 months, respectively, showing obvious improvement of hydronephrosis and renal function. The restricture degree of pure balloon dilatation treatment was less than 40%, and all double Jstents remained in the right place.Conclusion Interventional management via lower urinary tract for ureteral stricture is a safe, effective and simple technique, with minimum trauma and less complication.