经皮肾穿刺顺行置管术治疗膀胱癌术后尿流改道输出道狭窄

Anterograde Percutaneous Endoluminal Therapy of Efferent Tract Stenosis after Urinary Diversion of Bladder Cancer

目的探讨经皮肾穿刺顺行置管术治疗尿流改道术后输出道狭窄的临床应用价值。方法2009年3月-2012年12月收治膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者2例及输尿管皮肤造121乳头狭窄患者1例，手术4次，狭窄段长度1～2cm，均采用经皮肾穿刺顺行置管术治疗，可弯曲导丝通过狭窄段后，置入单J管，留置8周后拔除。结果2例患者8周后成功拔除单J管，分别随访18和20个月无肾积水，1例回肠膀胱患者留置单J管术后12周因肾积水再次留置单J管，8周后拔除，随访36个月无肾积水。1例术后一过性高热，对症治疗后好转；1例血肌酐升高患者术后2d肾功能恢复正常；无出血及其他严重并发症发生。结论采用经皮肾穿刺顺行置管技术治疗尿流改道术后输出道狭窄效果良好、恢复快。

Objective To explore the clinical value on anterograde percutaneous endo-urologic therapy of efferent tract stenosis after urinary diversion. Methods From March 2009 to December 2012, two cases of stenoses of uretero-intestinal anastomosis and one case of stenosis due to cutaneous ureterostomy were catheter- ized single J stent by anterograde percutaneous endoluminal therapy after urinary diversion of bladder cancer. The length of stricture ranged from 1 to 2 cm. The single J stent was extubated 8 weeks after the operation. Results Two cases were extubated the sing J stent 8 weeks after the operation, and not found hydronephrosis during 18 and 20 months follow-up, respectively. One case was received reoperation due to hydronephrosis and indwelling sing J stent. No serious complication such as hemorrhage occurred except one of transient fever. Conclusion The anterograde percutaneous endoluminal therapy is suitable for treating efferent stenosis of uri- nary diversion with ideal effect and fast restoration.