Tapping Charles Ross, Briggs James H, Little Mark W, Bratby Mark J, Phillips-Hughes Jane, Crew Jeremy P, Boardman Phil
Department of Radiology, Oxford University Hospitals, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK; Department of Radiology, Oxford University Hospitals, Churchill Hospital, Headington, Oxford, United Kingdom.
Department of Radiology, Oxford University Hospitals, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
J Vasc Interv Radiol. 2014 Aug;25(8):1250-6. doi: 10.1016/j.jvir.2014.02.013. Epub 2014 Apr 1.
To assess the safety, success, and complications associated with retrograde ureteric stent insertion via the ileal conduit.
The study population comprised 35 consecutive patients (17 men and 18 women; mean age, 55 y; age range, 40-75 y) requiring primary (20 stents) and exchange (70 stents) retrograde ureteric stent insertion via the ileal conduit over a 3-year period. Patient demographic data, procedural and technical data, and clinical follow-up data were collected.
Technical success was 90% (18 of 20) for primary stent placement and 100% (70 of 70) for stent exchange. There were two immediate complications (< 24 h) of sepsis and ureteric injury and one early complication (> 25 h but < 30 d) of sepsis requiring observation and medical management. Difficult procedures (defined as a fluoroscopy screening time > 31 min) and technical failures were found to be associated with encrusted stents visualized on prior computed tomography (P = .012), increased length of ileal conduit (> 20 cm) (P = .023), and ileal conduit kink (< 90 degrees) (P = .032). Only the occurrence of encrusted stents visualized on prior computed tomography (P = .022) was associated with complications.
Retrograde placement of ureteric stents via the ileal conduit is safe and effective. Retrograde stent placement should be considered the treatment option of choice for a first-time occurrence of obstructive uropathy at the ureteroileal anastomosis.
评估经回肠膀胱通道逆行输尿管支架置入术的安全性、成功率及并发症。
研究对象为连续35例患者（17例男性，18例女性；平均年龄55岁；年龄范围40 - 75岁），在3年期间需要经回肠膀胱通道进行初次（20枚支架）和更换（70枚支架）逆行输尿管支架置入。收集患者人口统计学数据、手术及技术数据以及临床随访数据。
初次支架置入的技术成功率为90%（20例中的18例），支架更换的成功率为100%（70例中的70例）。有2例即刻并发症（<24小时），分别为脓毒症和输尿管损伤，1例早期并发症（>25小时但<30天）为脓毒症，需要观察及药物治疗。发现困难操作（定义为透视筛查时间>31分钟）和技术失败与先前计算机断层扫描显示的支架结壳有关（P = 0.012），回肠膀胱通道长度增加（>20 cm）（P = 0.023），以及回肠膀胱通道扭结（<90度）（P = 0.032）。仅先前计算机断层扫描显示的支架结壳的出现（P = 0.022）与并发症有关。
经回肠膀胱通道逆行置入输尿管支架是安全有效的。对于输尿管回肠吻合口首次发生梗阻性尿路病，逆行支架置入应被视为首选治疗方案。
