Hwang T K, Seo S I, Kim J C, Yoon J Y, Park Y H, Yoon M S
Department of Urology, Catholic University of Korea, Seoul.
J Endourol. 1999 Sep;13(7):495-8. doi: 10.1089/end.1999.13.495.
The long-term result of percutaneous endourologic management in the relief of infundibular stricture is not clear. We reviewed the long-term efficacy in our series of patients.
Twenty-seven patients underwent percutaneous endourologic management between August 1990 and February 1996. This study included the 21 who could be followed for more than 2 years (mean 4.8 years). The causes of stricture were tuberculosis (N = 18; 86%) and stone (N = 3; 14%). We made a cold-knife incision in eight patients; the others underwent only dilation with fascial dilators from 20F to 30F. Success was defined as symptomatic improvement and radiographic resolution of obstruction.
The overall success rate was 76% (16 of 21). Seven of the eleven patients (64%) with concomitant ureteral stricture had a successful result. In the nine patients with multiple infundibular strictures, five procedure (56%) were successful. The success rates of the cold-knife or fascial dilator were 88% (7 of 8) and 69% (8 of 13), respectively. In the five patients in whom the procedure failed, ureteral stricture was associated in four and multiple infundibular strictures in four. All of them had tuberculous infundibular strictures. No significant difference in the success rate was observed according to the duration of indwelling catheter. There was no significant complication except pyelonephritis in four patients, which was controlled with conservative treatment.
Percutaneous endourologic management is an effective and safe procedure to treat renal infundibular stricture. Risk factors for failure are multiple infundibular strictures and concomitant ureteral stricture. If the procedure does fail, other treatments have not been compromised. Cold-knife incision seems to be more effective than dilation.
经皮腔内泌尿外科治疗肾盂漏斗部狭窄的长期疗效尚不清楚。我们回顾了我们系列患者的长期疗效。
1990年8月至1996年2月期间，27例患者接受了经皮腔内泌尿外科治疗。本研究纳入了21例能够随访超过2年（平均4.8年）的患者。狭窄原因包括结核（N = 18；86%）和结石（N = 3；14%）。8例患者进行了冷刀切开；其余患者仅用筋膜扩张器从20F扩张至30F。成功定义为症状改善和梗阻的影像学消退。
总体成功率为76%（21例中的16例）。11例伴有输尿管狭窄的患者中有7例（64%）治疗成功。9例有多发性肾盂漏斗部狭窄的患者中，5例手术（56%）成功。冷刀切开或筋膜扩张器的成功率分别为88%（8例中的7例）和69%（13例中的8例）。在5例手术失败的患者中，4例伴有输尿管狭窄，4例有多发性肾盂漏斗部狭窄。他们均患有结核性肾盂漏斗部狭窄。根据留置导管的时间，成功率无显著差异。除4例患者发生肾盂肾炎且经保守治疗得到控制外，无明显并发症。
经皮腔内泌尿外科治疗是治疗肾肾盂漏斗部狭窄的一种有效且安全的方法。失败的危险因素是多发性肾盂漏斗部狭窄和伴有输尿管狭窄。如果手术确实失败，其他治疗方法不受影响。冷刀切开似乎比扩张更有效。
