Lang E K
Radiol Clin North Am. 1986 Dec;24(4):601-13.
Ureteral strictures are categorized by age, etiology, location, and length of stricture. On the basis of history, the status of vascular perfusion of the involved ureteral segment and possible presence of devitalization are projected. Transluminal dilatation of ureteral strictures can be performed via a retrograde or antegrade approach. The age of the stricture and status of vascular supply to the involved and adjacent segments of the ureter are the most critical criteria influencing long-term results of transluminal dilatation. The technique of bougie dilatation and placement of balloons across strictures at various sites is discussed. The advantages of bougie versus balloon dilatation and the need for postdilatation stenting to preclude restricturing are analyzed. In fresh strictures, not complicated by devascularization, a 90 per cent salutary response to transluminal dilatation can be anticipated, regardless of location of the stricture, ureteroneocystostomy, or ureteroileostomy. Most poor results of transluminal dilatation occur in strictures compromised by severe devascularization attendant to surgical procedures, radiation therapy, fulminating inflammatory processes, neoplasms, or any combination of these. Decompression and drainage of the kidney by an internalized stent are advocated for the treatment of strictures caused by recurrent and uncontrolled neoplasm.
输尿管狭窄根据年龄、病因、部位和狭窄长度进行分类。根据病史，推测受累输尿管段的血管灌注状况以及是否可能存在组织活力丧失。输尿管狭窄的腔内扩张可通过逆行或顺行途径进行。狭窄的时间以及输尿管受累段和相邻段的血供状况是影响腔内扩张长期效果的最关键标准。文中讨论了探条扩张技术以及在不同部位跨越狭窄放置球囊的方法。分析了探条扩张与球囊扩张的优缺点以及扩张后放置支架以防止再狭窄的必要性。在未并发血运障碍的新鲜狭窄中，无论狭窄部位、输尿管膀胱吻合术或输尿管回肠吻合术如何，预计腔内扩张的有效率可达90%。腔内扩张效果不佳大多发生在因外科手术、放射治疗、暴发性炎症过程、肿瘤或这些情况的任何组合导致严重血运障碍的狭窄中。对于由复发性和无法控制的肿瘤引起的狭窄，主张通过内置支架进行肾脏减压和引流。
