摘要
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.
出处
《北京大学学报(医学版)》
CAS
CSCD
北大核心
2015年第4期634-637,共4页
Journal of Peking University:Health Sciences
关键词
输尿管梗阻
肾盂
肾造口术
经皮
Ureteral obstruction
Kidney pelvis
Nephrostomy
percutaneous