Amendola M A, Banner M P, Pollack H M, Gordon R L
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
AJR Am J Roentgenol. 1989 Jan;152(1):97-102. doi: 10.2214/ajr.152.1.97.
Using a perurethral transvesical approach, we attempted a total of 180 varied pyeloureteral uroradiologic interventional procedures during a 20-month period; 168 were successfully accomplished (93% success rate). We used standard interventional equipment, fluoroscopy, and (for access to the upper urinary tract) ureteral catheters that had been partially or completely inserted at cystoscopy by urologists. The successful procedures included insertion of double-pigtail ureteral stents (42 procedures), insertion of single-pigtail ureteral stents (47), advancement of arrested or incompletely inserted retrograde ureteral catheters (42), urothelial biopsy (30), balloon dilatation of ureteral strictures (three), retrograde cannulation of ureteropelvic junction obstructions that could not be negotiated in a percutaneous antegrade fashion (three), and ureteral stone extraction (one). The method was unsuccessful in 12 patients. Failures were due to caudal migration of a ureteral catheter into the bladder in eight patients and to an inability to advance a guidewire beyond an area of ureteral obstruction or perforation in four. Although most commonly used as an adjunct to extracorporeal shock-wave lithotripsy of renal and proximal ureteral calculi, the perurethral approach was extremely valuable for a wide variety of other indications. Significant complications, encountered in 5% of the procedures, included urosepsis (two), ureteral perforations (five), and cannulation of a false ureteral lumen (two). These problems resolved without sequelae with conservative management. The perurethral transvesical approach represents a relatively simple, safe, and expeditious interventional uroradiologic method. It frequently obviated other more invasive interventions such as percutaneous nephrostomy, ureteroscopy, or surgery.
采用经尿道膀胱途径，我们在20个月的时间里共尝试了180例不同的肾盂输尿管泌尿系统放射介入手术；其中168例成功完成（成功率为93%）。我们使用了标准的介入设备、荧光透视检查，以及（用于进入上尿路）泌尿科医生在膀胱镜检查时部分或完全插入的输尿管导管。成功的手术包括插入双猪尾输尿管支架（42例手术）、插入单猪尾输尿管支架（47例）、推进受阻或未完全插入的逆行输尿管导管（42例）、尿路上皮活检（30例）、输尿管狭窄球囊扩张（3例）、逆行插管治疗无法经皮顺行处理的输尿管肾盂连接处梗阻（3例）以及输尿管结石取出（1例）。该方法在12例患者中未成功。失败原因包括8例患者输尿管导管尾端移入膀胱，以及4例患者无法将导丝推进至输尿管梗阻或穿孔部位以外。尽管经尿道途径最常用于辅助肾和近端输尿管结石的体外冲击波碎石术，但它对于多种其他适应证也极具价值。5%的手术出现了严重并发症，包括尿脓毒症（2例）、输尿管穿孔（5例）以及误插输尿管假腔（2例）。这些问题通过保守治疗得以解决，未留下后遗症。经尿道膀胱途径是一种相对简单、安全且快捷的泌尿系统放射介入方法。它常常避免了其他更具侵入性的干预措施，如经皮肾造瘘术、输尿管镜检查或手术。
