经皮肾通道顺行输尿管软/硬镜联合输尿管镜治疗恶性输尿管梗阻

Oblique supine lithotomy position percutaneous antegrade ureteral endoscopy combined with retrograde ureteroscopy for complex malignant ureteral obstruction

目的探讨斜仰卧截石位经皮肾通道顺行输尿管软/硬镜联合输尿管镜置入双J管治疗输尿管支架管置入失败的恶性肿瘤致输尿管梗阻的安全性及临床效果。方法回顾性收集并分析2016年10月至2019年1月我院收治的25例恶性肿瘤引起的输尿管梗阻患者的资料,上述患者均因常规逆行膀胱镜或输尿管镜置双J管失败,进而以斜仰卧截石位利用经皮肾通道顺行输尿管软/硬镜联合输尿管镜置入双J管。结果25例患者(32侧输尿管梗阻)中,1例因肿瘤侵犯输尿管造成双侧输尿管管腔完全闭塞,双J管置入失败。其余24例均成功放置双J管(成功率93.7%)。手术时间平均(57.4±22.4)min,平均住院时间(5.5±1.9)d,术中无严重肾出血,无输尿管穿孔及撕脱。术后6~14 d拔除肾造瘘管,拔除肾造瘘管后随访12个月,肾积水缓解。结论斜仰卧截石位皮肾通道顺行输尿管软/硬镜联合输尿管镜置入双J管治疗输尿管支架管置入失败的恶性肿瘤引起的输尿管梗阻安全、有效,值得临床推广。

Objective To investigate the clinical safety and effects of oblique supine lithotomy position percutaneous antegrade ureteral flexible/rigid endoscopy combined with retrograde ureteroscopy in the treatment of ureteral stent implantation failure ureteral obstruction caused by malignant tumors.Methods A retrospective study was conducted to collect and analyze the data of 25 patients with ureteral obstruction caused by malignant tumors treated in our hospital from October 2016 to January 2019.All these patients failed of double J stent placement under conventional retrograde cystoscopy or ureteroscopy.Under the oblique supine lithotomy position,a double J tube was placed by percutaneous renal channel antegrade ureteral flexible/rigid endoscopy combined with ureteroscopy.Results Double J tubes were successfully placed in 24 cases(30 sides of ureter,93.7%success rate),except for 1 case failed due to complete occlusions of the bilateral ureteral lumen by tumor invasion.The average operation time was(57.4±22.4)minutes and the average hospital stay was(5.5±1.9)days.There was no severe renal hemorrhage and no ureteral perforation and avulsion during the operation.The nephrostomy tube was removed 6-14 days after the operation.Hydronephrosis was significantly relieved during the 12 months follow-up.Conclusions Oblique supine lithotomy position percutaneous antegrade ureteral flexible/rigid endoscopy combined with retrograde ureteroscopy for the treatment of ureteral stent implantation failure ureteral obstruction caused by malignant tumors is safe and effective,and worthy of clinical promotion.