内镜下输尿管金属支架逆行置入在肿瘤性输尿管梗阻中的应用价值

Clinical value of retrograde metallic ureteral stent under endoscopy treating the patients with malignant ureteral obstruction

目的:探讨内镜下输尿管金属支架逆行置入在解除肿瘤性输尿管梗阻中的临床价值。方法:回顾性分析2013年4月~2015年10月我院采用内镜下输尿管金属支架逆行置入治疗9例因肿瘤致输尿管梗阻患者的临床资料。男3例,女6例;平均年龄49岁;其中双侧输尿管梗阻5例,单侧4例。所有患者术前均行肾功能、泌尿系彩超及CT扫描或CTU检查,了解肾积水程度及输尿管梗阻部位。9例患者利用输尿管硬镜在X线透视下逆行置入金属支架,术后定期复查肾功能、KUB及腹部CT平扫等。术后每半年或1年更换金属支架管。结果:9例患者均逆行置入金属支架管,其中2例先行导丝引导下球囊扩张后顺利置入。术后KUB均显示输尿管金属支架放置位置合适。5例患者术后24h尿量明显增加,肾功能恢复正常或接近正常。患者术前发热及腰痛等不适症状缓解,术后随访患侧肾积水范围均较术前缩小或明显缓解,2例患者因金属支架下移及金属支架末端附着结石给予提前更换,其余5例均每年更换。结论:内镜下输尿管金属支架逆行置入具有创伤小、恢复快、可重复治疗等优点,是用于治疗因恶性肿瘤压迫输尿管梗阻的有效方法。

Objective：To investigate the clinical value of retrograde metallic ureteral stent under endoscopy treating the patients with malignant ureteral obstruction.Method：The retrospective study on clinical data of nine patients who received retrograde metallic ureteral stent under endoscopy because of malignant ureteral obstruction between Apr.2013 and Oct.2015 was done.There were three males and six females,whose mean age was 49 years old.Five of them were found bilateral and other four were found unilateral ureteral obstruction.In order to know the degree of hydronephrosis and ureteral obstruction,all patients underwent kidney function testing,ultrasound and CT scan or CTU examination preoperatively.These nine patients were retrogradely implanted metallic ureteral stent under ureteroscopy by X-ray.All of them were reviewed kidney function testing,abdomen KUB and CT scan postoperatively regularly.Result：Nine patients were retrogradely implanted metallic ureteral stent.Two of them were successfully placed by balloon dilation with the wire guide.All patients＇ stents displayed a suitable position by abdominal X-ray examination postoperatively.Five patients＇ 24 hours urinary volume increased significantly,and renal function improved excellently with creatinine recovered.Hydronephrosis relieved or disappeared postoperatively in all person,and their fever and back pain also relieved.Two of the patients were exchanged stent in advance because of encrustation and placement,the others were exchanged their stent every year.Conclusion：Treatment of putting metallic ureteral stent retrograde under endoscopy has the advantages of less invasion and rapid recovery.It could be an efficient method for the treatment of malignant ureteral obstruction.