逆行或顺行球囊扩张术治疗输尿管狭窄

Retrograde or anterograde balloon dilatation for ureteral strictures

目的探讨经尿道逆行或经皮肾穿刺顺行球囊扩张术治疗输尿管狭窄的临床效果。方法 2012年6月~2013年6月,对24例输尿管狭窄患者行逆行或顺行球囊扩张术,均为单侧狭窄,其中左侧13例,右侧11例;经B超、利尿性肾图、静脉尿路造影（IVU）和（或）CTU、逆行肾孟造影等检查确诊;经皮肾镜技术（PCNL）术或输尿管镜下碎石取石术后狭窄13例,腹腔镜下输尿管切口取石术后狭窄6例,输尿管端端吻合术后狭窄4例,输尿管膀胱再植术后狭窄1例。术后随访3~12个月,行利尿性肾图、IVP及B超检查。结果逆行置管成功23例,行逆行球囊扩张术,并留置双J管;逆行置管失败1例,行经皮肾穿刺顺行球囊扩张术,并留置双J管。24例球囊扩张术的手术时间30~80 min,平均45 min,术后住院时间2~4 d,平均3 d。术后3个月拔除双J管,24例患者中治愈13例,好转9例,无效2例。结论逆行或顺行球囊扩张术治疗输尿管狭窄安全、有效、微创。

[Objective] To evaluate the efficacy of retrograde or anterograde balloon dilatation for the treatment of ureteral strictures. [Methods] Between June 2012 and June 2013, retrograde or anterograde balloon dilatation was performed in 24 consecutive patients with ureteral strictures. Of 24 patients,thirteen had ureteral stricture on the left side and 11 on the right side. The diagnosis was established by renal ultrasonography, diuretic renal scan, intravenous urography（IVU） or/and computed tomography urography（CTU）, retrograde urography imaging. Of 24 patients, thirteen ureteral strictures occurred secondary to PCNL or ureteroscopy lithotripsy, six secondary to laparooscopic ureterolithotomy, four secondary to ureteral end to end anastomosis and one secondary to bladder ureter reimplantation. With the follow-up of 3~12 months, ultrasonography, diuretic renal scan and IVU were routinely performed. [Results] Retrograde catheter insertion was completed successful in 23 cases and retrograde balloon dilatation was performed in these patients. Retrograde catheter insertion was fail in one case and percutaneous renal puncture and anterograde balloon dilatation was performed. The mean operative time of 24 cases was 45（range 30 to 80） min. The mean hospital stay was 3（range 2~4） d. The DJ stent was removed in 3 months postoperatively. Of 24 patients, thirteen showed curative, nine showed improved and two showed invalid.[Conclusion] Retrograde or anterograde balloon dilatation for ureteral strictures could be a safe, effective and minimally invasive procedure.