Bultitude Matthew F, Tiptaft Richard C, Glass Jonathan M, Dasgupta Prokar
Department of Urology, Guy's and St. Thomas' Hospital, London, United Kingdom.
Urology. 2003 Oct;62(4):622-6. doi: 10.1016/s0090-4295(03)00506-5.
To present our series of patients with ureteral stent encrustation and give indwelling times and management. Encrustation is one of the most serious complications of ureteral stents.
A retrospective review was undertaken of all encrusted stents during a 4-year period. The inclusion criterion was a stent that required some form of intervention above the ureteral orifice to remove it. Combinations of extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery were used to achieve stent removal.
Forty-nine impacted encrusted stents were treated in 41 patients. Of these, 75.5% had become encrusted within 6 months and 42.8% within 4 months. The mean indwelling time was 5.6 months. Forty-seven stents were removed by endourologic techniques, with 4 requiring extracorporeal shock wave lithotripsy alone, 28 ureteroscopy, and 10 a combination of both. Five patients underwent successful percutaneous nephrolithotomy. One patient underwent open surgery, and in one removal failed. The mean number of procedures per patient was 1.94.
Stent encrustation can pose a serious challenge to the endourologist, and indwelling times should be minimized to avoid problems. Patients often require multiple treatments and a combination of extracorporeal shock wave lithotripsy and ureteroscopy offers highly successful outcomes and often avoids the need for more invasive techniques.
介绍我们收治的输尿管支架管结壳患者系列病例，并给出留置时间及处理方法。结壳是输尿管支架管最严重的并发症之一。
对4年期间所有发生结壳的支架管进行回顾性研究。纳入标准为需要在输尿管口上方进行某种形式干预才能取出的支架管。采用体外冲击波碎石术、输尿管镜检查、经皮肾镜取石术及开放手术等联合方法取出支架管。
41例患者共治疗49枚嵌顿性结壳支架管。其中，75.5%在6个月内发生结壳，42.8%在4个月内发生结壳。平均留置时间为5.6个月。47枚支架管通过腔内泌尿外科技术取出，其中4枚仅需体外冲击波碎石术，28枚通过输尿管镜检查取出，10枚采用两种方法联合取出。5例患者经皮肾镜取石术成功。1例患者接受开放手术，1例取出失败。每位患者的平均手术次数为1.94次。
支架管结壳会给腔内泌尿外科医生带来严峻挑战，应尽量缩短留置时间以避免出现问题。患者通常需要多次治疗，体外冲击波碎石术与输尿管镜检查联合使用成功率很高，且常常无需采用更具侵入性的技术。
