金属覆膜支架在宫颈癌放射疗法后输尿管狭窄的应用

Application of Allium ureteral stent in ureteral stricture caused by radiotherapy for cervical cancer

目的:探讨应用Allium金属覆膜输尿管支架治疗因宫颈癌放射疗法导致输尿管狭窄的有效性及技术要点。方法:回顾性分析江苏省老年病医院泌尿外科2020年10月至2023年3月间收治的因宫颈癌放射疗法后导致输尿管狭窄患者29例,均经术中输尿管逆行造影结合输尿管镜探查,明确狭窄段长度为6~22 cm,其中单侧狭窄13例,双侧狭窄16例(55.2%),共45侧。采用输尿管镜结合X线下介入的治疗方式,完成输尿管狭窄腔内扩张,并植入Allium金属覆膜输尿管支架定形。结果:全部患者均成功完成输尿管狭窄扩张成形,5例同期植入双侧输尿管支架。14侧(31.1%)支架12 cm,31侧(68.9%)支架20 cm。早期伴有植入侧腹部持续隐痛者8侧(17.8%),均为20 cm支架植入者,可耐受且2个月内症状均消失。3例(10.3%)有一过性肉眼血尿。2例(6.9%)出现有发热症状的尿路感染,1例抗生素治疗感染可控,1例(3.4%)因为持续返流严重伴感染后去除支架改肾造瘘引流。结论:采用输尿管镜和X线引导结合的方式,可完成Allium金属覆膜输尿管支架狭窄腔内成形,推荐多使用20 cm金属覆膜支架,可有效避免术后出现再狭窄的机会。

Objective:To investigate the efficacy and technical aspects of Allium ureteral stents in treating ureteral strictures caused by radiotherapy for cervical cancer.Methods:29 cases of ureteral stenosis resulting from cervical cancer radiotherapyadmitted to the Department of Urology at Jiangsu Geriatrics Hospital from October 2020 to March 2023 were retrospectively analysed.Intraoperative retrograde ureteral angiography combined with ureteroscopy revealed that the length of the strictures ranged from 6cm to 22cm,including unilateral stenosis in 13 cases and bilateral stenosis in 16 cases(55.2%),totaling 45 sides.Ureteroscopy combined with X-ray intervention was employed for dilating the ureteral strictures,followed by implantation of Allium ureteral stents for reshaping.Results:Successful completion of ureteral stricture dilation was achieved in all patients,with simultaneous bilateral placement of stents performed in five patients.Among these placements,there were fourteen sides(31.1%)where a twelve-centimeter-long stent was used and thirty-one sides(68.9%)where a twenty-centimeter-long stent was utilized.Eight patients(17.8%)experienced persistent dull pain on the implanted side of their abdomen during early stages;however,all symptoms disappeared within two months post-implantation.Three cases(10.3%)exhibited transient gross hematuria while two cases(6.9%)developed febrile urinary tract infections;one case responded well to antibiotic treatment while another case required nephrostomy drainage after removal due to persistent reflux and severe infection.Conclusion:The combination approach involving ureteroscopy and X-ray guidance enables successful implementa‐tion of Alliumureteral stents.It is recommended to preferentially employ twenty-centimeter-long ureteral stents as they effectively reduce the likelihood of restenosis following surgery.