DSA引导下顺行植入输尿管支架在恶性肿瘤所致输尿管狭窄的优势分析

DSA-guided anterograde implantation of ureteral stent for malignant ureteral stenosis: analysis of its clinical advantages

目的探讨DSA引导下经皮穿刺肾盏置入输尿管支架在恶性肿瘤所致输尿管狭窄的可行性。方法收集2012年10月至2015年4月因恶性肿瘤导致输尿管狭窄伴肾积水40例患者、45条输尿管狭窄。应用C臂CT成像技术,经皮肾穿刺肾盏,在导管导丝的辅助下植入输尿管支架,解除输尿管梗阻。其中30例在输尿管镜或膀胱镜下植入输尿管支架操作失败并采取DSA引导下植入支架;10例直接行DSA引导下植入支架。35例为单侧输尿管狭窄,5例为双侧狭窄,共45条输尿管受累。分析DSA引导下顺行植入输尿管支架的优势。结果 45条受累输尿管中42条输尿管例植入输尿管支架取得成功,3条因导管导丝未能通过狭窄段未能置入,于患侧留置外引流管缓解肾盂积水。结论对于恶性肿瘤所致输尿管狭窄患者,DSA引导下经皮肾穿刺植入输尿管支架的方法简便易行,成功率高,并发症少,术后生活质量好。

Objective To evaluate the feasibility of DSA-guided percutaneous puncture of renal calyx to place ureteral stent in treating malignant ureteral stenosis. Methods A total of 40 patients with malignant ureteral stenosis complicated by hydronephrosis （45 obstructed ureters in total）, who were encountered at authors＇ hospital during the period from October 2012 to April 2015, were collected. Under C-arm CT guidance, percutaneous puncture of renal calyx was performed and with the help of catheter and guidewire the ureteral stent was implanted to relieve ureteral obstruction. Ureteroscopy or cystoscopy implantation of ureteral stent failed in 30 patients, and DSA-guided stenting had to be carried out; in 10 patients DSA- guided stenting was directly performed. Unilateral ureteral stenosis was seen in 35 patients, and bilateral ureteral stenoses were observed in 5 patients, a total of 45 ureters were involved. The technical advantages of DSA-guided anterograde implantation of ureteral stent were analyzed. Results Of the 45 involved ureters, implantation of ureteral stent was successfully accomplished in 42 and failed in 3 because the guidewire could not pass through the ureteral narrowed segment; for the treatment of these 3 narrowed ureters an external drainage tube had to be inserted into the affected renal pelvis to relieve hydronephrosis. Conclusion For the treatment of malignant ureteral stenosis, DSA-guided percutaneous puncture of renal calyx with subsequent implantation of ureteral stent is simple and easy with higher success rate and fewer complications, besides, the patients can enjoy a good quality of life after the operation.