输尿管双J支架管置入术后再次梗阻因素分析

Ureteral re-obstruction after double-J ureteral stent tube implantation: analysis of the risk factors

目的探讨输尿管双J支架管置入术后再次梗阻的影响因素。方法回顾性分析121例肿瘤性肾盂积水置入输尿管双J管的临床资料,对肿瘤进展、尿盐结垢、肾小球滤过功能、每日尿量、尿路感染、留管时间、下尿路功能及双J管内径等因素总结,分析输尿管再次梗阻的原因及预防方法。结果 121例患者48例再梗阻,其中肿瘤进展、尿盐结垢、尿路感染、留置时间是主要影响因素,占87.5%;肾小球滤过功能、每日尿量及下尿路功能也是重要因素,占12.5%。另外,双J管内径也是影响再梗阻的因素。通过局部控制肿瘤、改善饮用水及按时换双J管等相应措施,44例未再梗阻,4例因肿瘤进展再梗阻改外引流。结论输尿管双J管置入后,积极抗肿瘤治疗、降低饮用水硬度、改善肾功能、多饮水排尿、预防尿路感染、缩短留管时间、纠正下尿路功能障碍能有效地延缓或预防双J管再次梗阻。

Objective To investigate the possible factors related to the ureteral re-obstruction after double-J ureteral stent tube implantation. Methods The clinical date of 121 patients with hydronephrosis caused by renal tumor, who had received double-J ureteral stent tube implantation treatment, were retrospective analyzed. The factors that might cause ureteral re-obstruction, such as tumor progression, urinary salt scaling, glomerular filtration function, daily urine volume, urinary tract infection, tube- indwelling time, the function of lower urinary tract, double-J tube diameter, etc. were analyzed, the reasons causing ureteral re-obstruction were summarized, and the preventive measures were suggested. Results Of the 121 patients, ureteral re-obstruction occurred in 48. Among them, the tumor progression, urinary salt scaling, urinary tract infection and the tube-indwelling time were the main inducing factors （87.5%）; glomerular filtration function, daily urine volume and the function of lower urinary tract were also the important factors （12.5%）. Besides, the inner diameter of double-J ureteral stent tube was also a factor that affected the occurrence of re-obstruction. After corresponding measures were adopted, including local control of tumor, improvement of drinking water and replacement of double-J stent tube on time, etc. no recurrence of re-obstruction was observed in 44 patients, and in the remaining 4 patients external drainage had to be employed as re- obstruction occurred due to tumor progression. Conclusion In order to protect the ureter from being re-obstructed after the implantation of double-J stent tube, active measures should be taken after double-J stent tube implantation; the effective measures include anti-tumor treatment, reducing the hardness of drinking water, improving renal function, drinking more water and more micturition, prevention of urinary tract infection, shortening the tube-indwelling time, correcting the lower urinary tract dysfunction, and so forth.