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[上尿路内引流的风险与并发症]

[The hazards and complications of internal drainage of the upper urinary tract].

作者信息

Martov A G, Zenkov S S, Chepurov A K, Mazo E B, Pokrovskiĭ S K

出版信息

Urol Nefrol (Mosk). 1995 Jan-Feb(1):29-31.

PMID:7732628
Abstract

The causes, diagnosis, prevention and management of complications arising in insertion of internal ureteral stents have been analyzed basing on the results of 289 procedures in 272 patients. Dangers and complications related to drainage of upper urinary tracts (UUT) may be divided into technological (arising when inserting or removing the stent) and clinical (arising within the time of the stent location in the UUT). Technological complications emerged in 25 cases (8.7%). Of them, iatrogenic ureteral perforation occurred most frequently (9 cases, 3.1%). Clinical complications were registered in 41 patients (14.2%). Most common of them were: attacks of pyelonephritis due to vesicoureteral reflux and stent impassibility (19 and 9 patients, 6.6% and 3.1%, respectively). To ascertain the causes of the stent impassibility for urine, a complex of x-ray and ultrasound investigations was applied. The reflux is often provoked by the bladder drainage with urethral catheter. In the stent obstruction or concrement formation on it, the removal and changes of the stent were combined with extracorporeal or contact lithotripsy. Spontaneous distal migration of the stent (8 cases) necessitated its transurethral removal. Insertion of inner ureteral stents is rarely complicated by spontaneous migration of the drainage above the ureteral ostium (1 case) and by development of arterial-ureteral fistula (1 case). Thorough roentgenoendoscopical control over the stent insertion and staying in the UUT assists prevention and treatment of complications consequent to UUT internal drainage.

摘要

基于272例患者289次手术的结果,对输尿管内支架置入术中出现的并发症的原因、诊断、预防及处理进行了分析。上尿路(UUT)引流相关的危险和并发症可分为技术方面的(在置入或取出支架时出现)和临床方面的(在支架位于UUT内期间出现)。技术并发症出现25例(8.7%)。其中,医源性输尿管穿孔最为常见(9例,3.1%)。41例患者(14.2%)出现临床并发症。其中最常见的是:由于膀胱输尿管反流和支架堵塞导致的肾盂肾炎发作(分别为19例和9例患者,6.6%和3.1%)。为确定尿液通过支架堵塞的原因,应用了一系列X线和超声检查。反流常由尿道导管进行膀胱引流引发。在支架梗阻或其上形成结石时,支架取出及更换与体外或接触性碎石术相结合。支架自发向远端迁移(8例)需要经尿道取出。输尿管内支架置入很少因引流在输尿管口上方自发迁移(1例)和动脉-输尿管瘘形成(1例)而复杂化。对支架置入及在UUT内留存进行全面的X线内镜控制有助于预防和治疗UUT内引流导致的并发症。

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