输尿管支架置入术治疗输尿管恶性梗阻伴肾功能不全的应用价值

Application Value of Ureteral Stent Placement in the Treatment of Malignant Ureteral Obstruction with Renal Insufficiency

目的研究给予输尿管恶性梗阻伴肾功能不全患者输尿管支架置入术治疗的价值。方法于2018年1月-2020年1月在该院接受输尿管支架顺行置入术治疗的患者中随机抽取34例,于接受输尿管支架逆行置入术治疗的患者中抽取34例,共68例,对比两组患者肾功能指标以及并发症。结果术后顺行组Scr(159.34±12.14)μmol/L,BUN(12.82±1.43)mmol/L,肾盂分离(1.30±0.24)cm。逆行组Scr(154.72±11.85)μmol/L,BUN(12.35±1.54)mmol/L,肾盂分离(1.33±0.21)cm,上述指标较术前均显著改善,组间对比差异无统计学意义(t=1.237、1.216、0.870,P>0.05);顺行组疼痛9例(26.5%),发热6例(17.6%),血尿3例(8.8%),合计18例(52.9%)。逆行组疼痛8例(23.5%),发热4例(11.8%),血尿4例(11.8%),合计16例(47.1%),两组对比差异无统计学意义(χ^2=1.042、1.560、1.137、1.574,P>0.05)。结论给予输尿管恶性梗阻伴发肾功能不全的患者输尿管支架置入术治疗,可有效改善肾功能指标,达到良好的临床疗效,顺行置入和逆行置入的临床疗效差异不大,要根据患者具体病情进行选择。长期置入支架存在一定刺激性,需要加强随访,配合其他治疗手段,改善预后效果。

Objective To study the value of ureteral stent implantation for patients with malignant ureteral obstruction and renal insufficiency.Methods From January 2018 to January 2020,34 patients were randomly selected from patients who received ureteral stent placement in this hospital,and 34 patients were selected from patients who received ureteral stent placement,totaling 68 cases.The renal function indexes and complications of the two groups were compared.Results In the anterograde group,Scr(159.34±12.14)μmol/L,BUN(12.82±1.43)mmol/L,and renal pelvis separation(1.30±0.24)cm.In the retrograde group,Scr(154.72±11.85)μmol/L,BUN(12.35±1.54)mmol/L,renal pelvis separation(1.33±0.21)cm,the above indicators were significantly improved compared with preoperatively,there was no statistically significant difference between the groups(t=1.237,1.216,0.870,P>0.05);in the anterograde group,there were 9 cases of pain(26.5%),6 cases of fever(17.6%),3 cases of hematuria(8.8%),a total of 18 cases(52.9%).In the retrograde group,there were 8 cases of pain(23.5%),4 cases of fever(11.8%),4 cases of hematuria(11.8%),a total of 16 cases(47.1%),there was no significant difference between the two groups(χ^2=1.042,1.560,1.137,1.574,P>0.05).Conclusion The treatment of ureteral stent implantation for patients with malignant ureteral obstruction with renal insufficiency can effectively improve renal function indexes and achieve good clinical curative effect.The clinical curative effect of antegrade and retrograde implantation is not much different.The specific condition of the patient is selected.Long-term stent implantation is irritating,and follow-up needs to be strengthened and other treatments are required to improve the prognosis.