不同类型输尿管内支架异位的特征及临床治疗方法(附36例报告)

Characteristics and clinical treatment of different types of ectopic ureteral stent(36 cases)

目的探讨输尿管内支架置入后不同类型位置异常的原因及处理。方法回顾性分析2014年1月-2020年1月36例在该院置入输尿管内支架并发现位置异常的患者资料,以寻找不同类型内支架位置异常的原因及合适的治疗方法。结果顺行置管导致内支架位置异常15例,逆行置管导致内支架位置异常20例,1例置入时位置正常但后续操作导致异位;34例在输尿管镜或膀胱镜下取出异位内支架,1例经皮肾造瘘取出内支架,1例开放手术取出异位支架。结论任何类型置管手术均有支架异位的可能。逆行置管导致内支架位置异常多发生于管腔内,建议膀胱镜下取出,必要时可选择经皮肾造瘘取出;腔内手术顺行置管导致的位置异常,优先考虑输尿管镜下取出,而异位于输尿管腔外的内支架可能需要借助开放手术取管。

Objective To investigate the causes and treatment of different types of abnormal location after ureteral stent implantation.Methods The clinical data of 36 cases with abnormal ureteral stent from January 2014 to January 2020 were retrospective analyzed.Explore the causes of different types of abnormal location and the appropriate treatment methods.Results 36 cases of different types of ureteral stents were found to be abnormal,antegrade catheterization caused 15 cases of abnormal stent placement;retrograde catheterization caused 20 cases of abnormal stent placement,1 case was placed at the normal position and subsequent operations caused ectopic;34 cases of ectopic stents were removed under ureteroscope or cystoscopy,1 case was removed by percutaneous nephrostomy,1 case was removed by open surgery.Conclusion Any type of catheter placement may have abnormal stent positions.The abnormal position of the internal stent caused by retrograde catheterization is mostly located in the lumen.It is recommended to remove the ectopic internal stent under cystoscopy.If necessary,percutaneous nephrostomy can be selected;the abnormal position caused by antegrade catheterization in intraluminal surgery is preferred The ureter is removed under the microscope,and the internal stent that is located outside the ureteral cavity may require open surgery to remove the tube.