Tschada R, Mickisch G, Rassweiler J, Knebel L, Alken P
Service d'Urologie, CHU Mannheim, Université de Heidelberg, Mannheim.
J Urol (Paris). 1991;97(2):93-7.
An internal urinary diversion of the upper urinary tract was planned in 107 patients with acute, stone-related or chronic tumor-induced ureteral obstruction. Acute ureteral obstruction (n = 34, group I): in 30 of 32 cases (94.1%), successful placement of an indwelling stent resulted in complete drainage in 28 of 30 patients (93.7%). In 2 cases, no satisfactory urine diversion was possible, despite several catheter changes and confirmed clearway through the installed catheters. Chronic ureteral obstruction (n = 73, group II): successful placement of the indwelling stent was possible in 63 of 73 (86.3%) cases. Complete urine diversion was achieved in only 25 patients (39.7%). Hydronephrosis was diminished in 28 patients (44.4%) and persisted or increased in 10 cases (15.9%), despite orthotopic positioning of the catheter and numerous stent changes. Complete urine drainage was achieved with an internal urine diversion in only 4 of 10 cases with chronic hydronephrosis. It is assumed that the reason for the high failure rate lies in the catheter construction and, with respect to chronic hydronephrosis, the reduced or non-existent contractility of the upper urinary tract in combination with the inevitable pressure connection between the upper and lower urinary tract.
对107例因结石相关急性病变或慢性肿瘤导致输尿管梗阻的患者进行了上尿路内尿液改道手术。急性输尿管梗阻(n = 34,第一组):32例中有30例(94.1%)成功置入了留置支架,其中28例(93.7%)患者实现了完全引流。2例患者尽管多次更换导管且确认导管通畅,但仍无法实现满意的尿液改道。慢性输尿管梗阻(n = 73,第二组):73例中有63例(86.3%)成功置入了留置支架。仅25例患者(39.7%)实现了完全尿液改道。28例患者(44.4%)肾积水减轻,10例患者(15.9%)肾积水持续或加重,尽管导管位置正常且多次更换支架。10例慢性肾积水患者中只有4例通过内尿液改道实现了完全尿液引流。据推测,高失败率的原因在于导管结构,对于慢性肾积水而言,还在于上尿路收缩力降低或丧失,以及上、下尿路之间不可避免的压力连接。