Liatsikos Evangelos N, Kagadis George C, Karnabatidis Dimitrios, Katsanos Konstantinos, Papathanassiou Zafiria, Constantinides Constantinos, Perimenis Petros, Nikiforidis George C, Stolzenburg Jens-Uwe, Siablis Dimitrios
Department of Urology, School of Medicine, University of Patras, and Laikon General Hospital, Athens, Greece.
J Urol. 2007 Jul;178(1):169-73. doi: 10.1016/j.juro.2007.03.061. Epub 2007 May 11.
We report our long-term experience with the management of benign ureteroileal anastomotic strictures using self-expandable metal stents.
A total of 16 male and 2 female patients with a mean+/-SD age of 72+/-7 years (range 66 to 78) with benign fibrotic strictures at the site of ureteroileal anastomosis underwent implantation of self-expandable metal stents with a nominal diameter of 6 to 8 mm. A total of 24 ureteroileal conduits were treated. The external nephrostomy tubes were removed after fluoroscopic validation of ureteral patency. Patients were followed with blood biochemistry, ultrasonography, urography and/or virtual endoscopy. Retrograde external-internal catheter insertion through the cutaneous stoma was performed in cases of recalcitrant stricture.
The technical success rate of ureteroileal stricture crossing and stenting was 100% (24 of 24 cases). Mean followup was 21 months (range 7 to 50). The clinical success rate during the immediate post-stenting period was 70.8% (17 of 24 cases). The 1 and 4-year primary patency rates were 37.8% and 22.7%, respectively. Secondary interventions included repeat balloon dilation in 15 ureters, of which 8 also underwent subsequent coaxial stent placement. The 1 and 4-year secondary patency rates were 64.8% and 56.7%, respectively. Except in 2 patients who died external-internal Double-J catheters continued to be inserted retrograde in 6 ureteroileal conduits. They are periodically exchanged to prevent mucous inspissation and stent encrustation.
Metal stents served as the definitive treatment for stricture in more than half of the cases, whereas in the remainder the stents allowed the uncomplicated and regular exchange of Double-J catheters in retrograde fashion. This combined, less invasive treatment for ureteroileal anastomotic strictures may help patients avoid surgical revision and preserve quality of life.
我们报告使用自膨式金属支架治疗良性输尿管回肠吻合口狭窄的长期经验。
共有16例男性和2例女性患者，平均年龄72±7岁（范围66至78岁），输尿管回肠吻合口处存在良性纤维化狭窄，接受了标称直径为6至8mm的自膨式金属支架植入术。共治疗24条输尿管回肠导管。在输尿管通畅经荧光镜确认后拔除体外肾造瘘管。对患者进行血液生化、超声、尿路造影和/或虚拟内镜检查随访。对于难治性狭窄病例，通过皮肤造口逆行插入内外双J导管。
输尿管回肠狭窄穿过及支架置入的技术成功率为100%（24例中的24例）。平均随访21个月（范围7至50个月）。支架置入后即刻的临床成功率为70.8%（24例中的17例）。1年和4年的初始通畅率分别为37.8%和22.7%。二次干预包括对15条输尿管进行重复球囊扩张，其中8条随后还进行了同轴支架置入。1年和4年的二次通畅率分别为64.8%和
