Li Jianhua, Chen Liang, Li Jianxing, Wang Xiaofeng
Department of Urology, Shangqiu First People's Hospital, Shangqiu 476100, China.
Department of Urology, Peking University People's Hospital, Beijing 100044, China. Email:
Zhonghua Yi Xue Za Zhi. 2014 Dec 16;94(46):3642-5.
To explore the clinical efficacy and safety of percutaneous renal access anterograde flexible ureteroscope plus retrograde balloon dilation in the treatment of complex lower ureterostenosis.
Under ultrasonic guidance, renal calices were successfully punctured for 78 patients with lower ureterostenosis. Then the tract was gradually expanded to 24 F with a metal dilator. Afterward upper ureter was expanded with a flexible ureteroscope sheath. Upon an insertion of guide wire into bladder, a 21 F balloon dilator was retrogradely placed in the narrow segment and maintained for 5 min. Then a D-J stent was antegradely deployed along the guide wire. And the clinical efficacy and safety were followed up.
6 F or 7/12 F D-J stent was successfully placed in 47 patients with unilateral ureterostenosis and 31 with bilateral ureterostenosis. The D-J stent was removed after 3 months. During a follow-up period of 3-9 months, 72 patients had gradually reduced hydronephrosis with an effective rate of 92.31%. Hydronephrosis remained unchanged or aggravated in 6 patients requiring regular replacement of D-J stent.
For complex middle or lower ureterostenosis, percutaneous renal access anterograde flexible ureteroscope plus retrograde balloon dilatation can reverse infection, hydronephrosis, renal dysfunction and other complications. And it is safe, effective and mini-invasive.
探讨经皮肾穿刺顺行输尿管软镜联合逆行球囊扩张术治疗复杂性输尿管下段狭窄的临床疗效及安全性。
在超声引导下，对78例输尿管下段狭窄患者成功穿刺肾盏，然后用金属扩张器将通道逐步扩张至24F。之后用输尿管软镜鞘扩张上段输尿管。在导丝插入膀胱后，将21F球囊扩张器逆行置入狭窄段并维持5分钟。然后沿导丝顺行置入D-J支架，并对临床疗效及安全性进行随访。
47例单侧输尿管狭窄患者和31例双侧输尿管狭窄患者成功置入6F或7/12F D-J支架。3个月后取出D-J支架。在3至9个月的随访期内，72例患者肾积水逐渐减轻，有效率为92.31%。6例患者肾积水无变化或加重，需定期更换D-J支架。
对于复杂性输尿管中下段狭窄，经皮肾穿刺顺行输尿管软镜联合逆行球囊扩张术可逆转感染、肾积水、肾功能不全等并发症，且安全、有效、微创。
