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原发性输尿管镜治疗致穹窿破裂的梗阻性输尿管结石。

Primary ureteroscopic treatment for obstructive ureteral stone-causing fornix rupture.

作者信息

Kalafatis Panagiotis, Zougkas Konstantinos, Petas Anastasios

机构信息

Department of Urology, General Hospital of Rhodos Island, Rhodos, Greece.

出版信息

Int J Urol. 2004 Dec;11(12):1058-64. doi: 10.1111/j.1442-2042.2004.00949.x.

Abstract

BACKGROUND

Management of fornix rupture (FR) by obstructive stone is comprised of extravasation control and the elimination of the obstruction. For all patients, management initially remains conservative under close follow up. Endoscopic management of FR involved with an obstructive stone of the ureter or the pelvi-ureteric junction (UPJ) consists mainly of stenting the ureter. Our endoscopic approach to this pathological entity comprises of the sole stenting of the ureter, as well as primary ureteroscopic lithotripsy followed by ureter stenting.

PATIENTS AND METHODS

In the Department of Urology at the General Hospital of Rhodos Island, Rhodos, Greece, over the last 15 years, 51 of 86 patients with FR due to an obstructive stone, were treated endoscopically. Twenty-two patients underwent sole stenting of the ureter (option A) and 29 patients underwent primary ureteroscopic lithotripsy and stenting (option B).

RESULTS

The overall primary 'successful outcome' was achieved in nine of the 22 patients (40.9%) in the group treated with sole stenting, while the remaining 59.1% required secondary interventions. However, 27 of the 29 patients (93.1%) treated with primary ureteroscopic lithotripsy and stenting required no auxiliary treatment. The primary successful outcome results for obstructive middle and lower ureteral stones with FR were eight out of 12 (66.6%) and 26 out of 27 (96.3%) for therapeutic options A and B, respectively. Upper obstructive ureteral stones with FR required secondary intervention in most cases, regardless of the therapeutic option chosen. (In nine out of 10 and one out of two cases for options A and B, respectively). The mean duration of hospitalization for options A and B were 7.6 and 5.3 days, respectively. The mean duration that the ureter stent remained in situ for A and B treatment options was 30.9 and 10.2 days, respectively.

CONCLUSIONS

Sole stenting of the ureter is reserved for infected FR or for stones of the upper ureter or the UPJ. Ureteroscopic lithotripsy followed by double-J stenting of the ureter may offer a quick and safe therapeutic alternative for distal and middle obstructive ureteral stones with FR.

摘要

背景

由梗阻性结石引起的穹窿破裂(FR)的处理包括控制外渗和消除梗阻。对于所有患者,初始处理在密切随访下保持保守。内镜处理与输尿管或肾盂输尿管交界处(UPJ)梗阻性结石相关的FR主要包括输尿管支架置入。我们针对这种病理情况的内镜方法包括单纯输尿管支架置入,以及一期输尿管镜碎石术加输尿管支架置入。

患者与方法

在希腊罗德岛罗德岛总医院泌尿外科,过去15年中,86例因梗阻性结石导致FR的患者中有51例接受了内镜治疗。22例患者接受了单纯输尿管支架置入(A方案),29例患者接受了一期输尿管镜碎石术加支架置入(B方案)。

结果

单纯支架置入组22例患者中有9例(40.9%)获得了总体主要“成功结局”,其余59.1%需要二次干预。然而,接受一期输尿管镜碎石术加支架置入的29例患者中有27例(93.1%)无需辅助治疗。对于伴有FR的梗阻性输尿管中下段结石,A和B治疗方案的主要成功结局分别为12例中的8例(66.6%)和27例中的26例(96.3%)。伴有FR的上尿路梗阻性输尿管结石在大多数情况下需要二次干预,无论选择何种治疗方案。(A和B方案分别为10例中的9例和2例中的1例)。A和B方案的平均住院时间分别为7.6天和5.3天。A和B治疗方案中输尿管支架原位留置的平均时间分别为30.9天和10.2天。

结论

单纯输尿管支架置入适用于感染性FR或上段输尿管或UPJ结石。输尿管镜碎石术加输尿管双J支架置入可为伴有FR的远端和中段梗阻性输尿管结石提供一种快速且安全的治疗选择。

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