Allium覆膜金属输尿管支架置入治疗输尿管狭窄的疗效评价

Allium ureteral stent for ureteral stenosis:outcomes and initial experiences

目的初步评价置入Allium覆膜金属输尿管支架治疗输尿管狭窄的疗效及并发症。方法回顾性分析2018年8月至2019年4月收治的39例诊断输尿管狭窄的患者资料,男22例,女17例;年龄18~67岁,平均(46±10)岁。术前B超及CTU检查均提示患侧肾脏积水,7例患者为双侧狭窄,共46侧输尿管狭窄。采用输尿管镜经尿道逆行置入Allium支架,均通过X线造影的方式确定狭窄部位并且在透视下留置支架。术后1个月及3个月复查B超、血肌酐,如出现反复发热或置入侧腰痛等梗阻症状则提前复查。随访观察疗效及并发症发生情况。结果本组46侧输尿管狭窄中,36侧输尿管狭窄置入1根Allium支架,3侧输尿管狭窄串联式置入2根Allium支架,7侧输尿管狭窄串联式置入3根Allium支架。术后随访3~9个月。4例患者术后1个月复查时仍提示患侧输尿管狭窄再次行Allium支架管置入,1例患者发生支架管移位后予以拔除支架,其余患者复查B超及血肌酐较术前均明显缓解,复查支架管位置正常。结论Allium覆膜金属输尿管支架用于治疗输尿管狭窄安全有效。对于长段输尿管狭窄,尤其是放疗后输尿管狭窄患者,需要多根串联置入,以达到理想的治疗效果。

Objective To explore the efficacy and complications of Allium ureteral stent in the treatment of ureteral stenosis.Methods The retrospective study enrolled 39 patients who received Allium ureteral stent placement due to ureteral stenosis during Aug.2018 and Apr.2019,including 22 males and 17 females,with an average age of(46±10)years(range 18 to 67 years).Preoperative B ultrasound and CTU indicated hydronephrosis in all cases.The ureteral stenosis was bilateral in 7 cases and unilateral in 32 cases,altogether 46 affected sides.Allium ureteral stent was inserted retrogradely with transureteroscope.The ureters were contrasted with x-ray to show the site of stenosis.Serum creatinine was tested and B ultrasound was conducted 1 month and 3 months after surgery.Patients who had repeated fever or renal colic of the affected side would be checked ahead of scheduled time.Outcomes and complications were observed.Results For all 46 affected sides,1 stent was inserted in 36 sides,2 stents were inserted in 3 sides,and 3 stents were inserted in 7 sides.All patients were followed up for 3 to 9 months.One month after operation,4 patients received a second stent insertion.Displacement of stent occurred in 1 case and the stent was removed.The other patients had improved creatine level and the stent was in the proper place.Conclusion Allium ureteral stent is an effective way to treat ureteral stenosis.For long ureteral stenosis,especially in patients receiving radiotherapy,more than one stent is needed for optimal efficacy.