特发性腹膜后纤维化并发外源性输尿管梗阻的尿路引流术的疗效和并发症。

Efficacy and complications of urinary drainage procedures in idiopathic retroperitoneal fibrosis complicated by extrinsic ureteral obstruction.

机构信息

Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands.

出版信息

Int J Urol. 2014 Mar;21(3):283-8. doi: 10.1111/iju.12234. Epub 2013 Aug 22.

DOI:10.1111/iju.12234

PMID:24033464

Abstract

OBJECTIVE

To investigate the efficacy and complications of urinary drainage procedures in patients with idiopathic retroperitoneal fibrosis complicated by ureteral obstruction.

METHODS

A retrospective study of 30 idiopathic retroperitoneal fibrosis patients involving 44 obstructed urinary units who underwent urinary drainage from January 2002 through April 2010 was carried out. Data of all diagnostic procedures, blood and urine cultures, and hospital admissions were collected and analyzed.

RESULTS

In 12 of 44 (27%) cases, percutaneous nephrostomy was carried out at the first step. Attempted ureteral stenting at the first step was successful in 25 of 32 (79%) cases, of which 20 (80%) cases could be managed successfully by ureteral stenting alone throughout the study period. Successful prolonged urinary drainage with percutaneous nephrostomy alone was accomplished in 10 cases, three at the first step and seven at the second step after failed intraureteral stent insertion or after unsuccessful maintenance of urinary drainage with an intraureteral stent. A total of 21 urinary tract infection episodes occurred in 11 patients. The incidence and accumulated incidence of acute pyelonephritis was 0.062 episodes/100 person-days and 30%, respectively. The incidence and accumulated incidence of urosepsis was 0.015 episodes/100 person-days and 6.6%, respectively. The overall number of complications did not differ between external and internal urinary drainage procedures (percutaneous nephrostomy, 21% vs intraureteral stent, 17.9%; P = 0.79).

CONCLUSION

Both intraureteral stent and percutaneous nephrostomy placement are a safe way to relieve urinary obstruction in idiopathic retroperitoneal fibrosis patients, and they have comparable complication rates. Over time, the need for using both management options in the same patient might be required. Hence, these techniques should be regarded as complementary.

摘要

目的

探讨伴有输尿管梗阻的特发性腹膜后纤维化患者行尿路引流术的疗效及并发症。

方法

对 2002 年 1 月至 2010 年 4 月期间收治的 30 例特发性腹膜后纤维化患者（44 个输尿管梗阻部位）行尿路引流的回顾性研究，收集并分析所有诊断程序、血和尿培养以及住院治疗数据。

结果

44 例（27%）患者行经皮肾造瘘术作为初始治疗，32 例（79%）患者在初始阶段尝试行输尿管支架置入术成功，其中 20 例（80%）患者可在研究期间全程通过输尿管支架置入术成功治疗，10 例患者通过单纯经皮肾造瘘术成功实现长期引流，其中 3 例在初次置入输尿管支架失败后，7 例在使用输尿管支架维持引流失败后进行，11 例患者共发生 21 次尿路感染，急性肾盂肾炎的发生率和累积发生率分别为 0.062 次/100 人-天和 30%，脓毒症发生率和累积发生率分别为 0.015 次/100 人-天和 6.6%。经皮肾造瘘术与输尿管内支架置入术的总体并发症发生率无差异（经皮肾造瘘术，21%；输尿管内支架，17.9%；P=0.79）。