24 F球囊扩张治疗输尿管狭窄的疗效及安全性评价

Evaluation of efficacy and safety of 24 F balloon dilation in the treatment of ureteral stricture

目的探讨输尿管镜或经皮肾镜下使用24 F球囊扩张术治疗良性输尿管狭窄的临床疗效及安全性评估。方法回顾性分析2014年1月至2016年1月龙川县中医院和中山大学附属第三医院输尿管镜下或经皮肾镜下24 F(20例)及18 F(20例)球囊扩张治疗40例良性输尿管狭窄患者临床资料。结果 24 F组中,20例患者均在输尿管镜或经皮肾镜引导下找到正确通道,完成球囊扩张手术。留置单条6 F输尿管内支架管10例,留置双条4.7 F输尿管支架管10例。留置双J管6~12个月。术后随访6~30个月,总体有效率90%(18/20)。18 F球囊扩张总体有效率65%(13/20),两组比较,总体有效率差异具有统计学意义(P<0.05)。两种型号的球囊扩张均未发生严重的出血或输尿管损伤。结论输尿管镜或经皮肾镜下24 F球囊扩张术是治疗良性输尿管狭窄安全、有效的手术方法,总体有效率高于18 F球囊扩张术,可以作为狭窄长度在1.0 cm以内的单侧肾功能轻-中度损害的良性输尿管狭窄病例的首选方案。

Objective To evaluate the clinical efficacy and safety of ureteroscopy or percutaneous nephrolithotomy using 24 F balloon dilation for benign ureteral stenosis. Methods The clinical data of 40 cases of benign ureteral stenosis treated with ureteroscopy or percutaneous nephrolithotomy with 24 F（20 cases） and 18 F（20 cases） balloon dilatation were retrospectively analyzed from January 2014 to January 2016. Results In the 24 F group, 20 cases had access to the correct channel by ureteroscopy or percutaneous nephrolithotomy to perform balloon dilatation. There were 10 cases indwelling 6 F ureteral stent and 10 cases indwelling 4.7 F ureteral stent. In addition,the double J reteral stents were indwelled for 6 to 12 months. After the follow-up for 6~30 months, the overall effective rate was 90%（18/20）. Fourteen cases were effectively dilated by one operation, and the overall effective rate of 18 F balloon dilatation was 65%（13/20）, and the overall effective rate between the two groups was statistically significant（P〈0.05）. No severe hemorrhage or ureteral injury occurred in these two types of balloon dilation. Conclusion 24 F balloon dilation is a safe and effective method for the treatment of benign ureteral stenosis by ureteroscopy or percutaneous nephrolithotomy, the total effective rate was higher than those of 18 F balloon dilation.So 24 F balloon dilation should be the preferred option for cases of benign ureteral stenosis with narrow moderate to moderate damage unilateral renal function within a narrow range of 1 cm.