经皮肾“三明治”腔内肾盂成形术治疗肾盂输尿管连接部梗阻

Percutaneous “sandwich”endopyeloplasty technique: a new endourological measure for ureteropelvic junction obstruction

目的：报道一种新的腔内成形技术——经皮肾＂三明治＂腔内肾盂成形术治疗肾盂输尿管连接部梗阻（ureteropelvic junction obstruction,UPJO）的临床疗效和安全性。方法：选取2012年1月至2013年12月期间使用经皮肾＂三明治＂腔内肾盂成形术治疗UPJO患者71例,其中先天性UPJO 12例,医源性UPJO59例;平均狭窄段长度为（1.4±0.8）mm,5例为肾盂输尿管连接部（ureteropelvic junction,UPJ）完全闭锁,患肾平均肾小球滤过率（glomerular filtration rate,GFR）为（19.8±10.8）m L/min。超声引导下建立皮肾通道后,UPJO狭窄段使用21 F（1 F=0.33 mm）或24 F输尿管扩张球囊采用球囊扩张-切开-球囊扩张的＂三明治＂技术扩大流出道,所有患者留置加强型输尿管支架管（7/14 F）作为狭窄段成形后的支撑。术后2个月撤除输尿管支架管,随访12~24个月。结果：一期手术成功69例,余2例因UPJ完全闭锁行二期手术成功,手术时间（39.3±24.2）min,术后肾周血肿1例,结石残余2例,无需要输血和发生尿源性败血症病例,无需要干预的尿外渗和体腔积液病例。随访期间,64例未再次出现UPJO的临床症状和影像学变化,7例撤除支架管后出现UPJ的再狭窄,其中6例为医源性UPJO,1例为先天性UPJO患者。结论：经皮肾＂三明治＂腔内肾盂成形术治疗UPJO,具有操作简便、微创、安全、有效等特点,对于具有适应证的患者可以作为一线的治疗选择。

Objective： To report a new endourological technique-percutaneous ＂sandwich＂endopyeloplasty for ureteropelvic junction obstruction（ UPJO）. Methods： In the study,71 patients with UPJO had endopyeloplasty by percutaneous balloon dilation before and after endopyelotomy,so called ＂sandwich＂endopyeloplasty. The ureter stent was removed after 2 months and all the patients were followed up at least 12 months by ultrasound,intravenous urogram（ IVU） or renal scintigraphy. Results： There were12 patients with primary UPJO,and 59 patients with iatrogenic UPJO after pyelolithotomy,pyeloplasty,ureteroscopic lithotripsy or percutaneous nephrolithotomy. The mean length of stricture was（ 1. 4 ± 0. 8）mm while 5 cases had complete stenosis ureteropelvic junction（ UPJ）. The mean glomerular filtration rate（ GFR） of the affected kidney was（ 19. 8 ± 10. 8） m L / min. 69 patientshad one-stage operation successfully and 2 patients with complete UPJ stenosis were recanalized in the secondary procedures. The mean time of the operation was（ 39. 3 ± 24. 2） min. The complications included 1 case of hemotoma,and 2 cases with residual stones. In the follow-up period,7 patients were re-obstructed. Conclusion：Percutaneous ＂sandwich＂endopyeloplasty shows good results for UPJO of selected patients with simple operation,minimal invasiveness,quick recovery and few severe complications.