Hwang T K, Park Y H
Department of Urology, Catholic University Medical College, Seoul, Korea.
J Endourol. 1993 Dec;7(6):493-6. doi: 10.1089/end.1993.7.493.
The stricture of the calix, renal pelvis, or ureter secondary to renal tuberculosis has been managed by nephrectomy, partial nephrectomy, ureteroileoneocystoplasty, or even pancaliceal-ileoneocystoplasty. To salvage the renal parenchyma, percutaneous endocalicotomy with or without endopyelotomy was performed in 10 patients. The main sites of stricture were an upper calix in six cases and a lower calix in four. A cold knife was used to incise the stricture, and a stenting two-section 14F endopyelotomy catheter was retained for 6 to 8 weeks. Postoperative intravenous urography revealed marked shrinkage of the dilated calix in seven cases, moderate shrinkage in one, and no change in two (success rate 80%). One of the patients in whom the procedure failed underwent partial nephrectomy, and the other is being followed. The only significant complication was one case of pyelonephritis. Endocalicotomy is a safe, less invasive, successful (in cases that a guidewire could pass), and parenchyma-saving procedure. Retrograde pyelography is mandatory just before the surgery because stricture can worsen during antituberculosis chemotherapy.
肾结核继发的肾盏、肾盂或输尿管狭窄过去一直通过肾切除术、部分肾切除术、输尿管回肠新膀胱成形术，甚至全肾盏-回肠新膀胱成形术来处理。为了挽救肾实质，对10例患者实施了有或无肾盂内切开术的经皮肾盏内切开术。狭窄的主要部位6例在上肾盏，4例在下肾盏。用冷刀切开狭窄处，并留置一段两节的14F肾盂内切开术导管支架6至8周。术后静脉肾盂造影显示，7例扩张肾盏明显缩小，1例中度缩小，2例无变化（成功率80%）。手术失败的患者中有1例行部分肾切除术，另一例正在随访中。唯一的严重并发症是1例肾盂肾炎。肾盏内切开术是一种安全、侵入性较小、成功的（在导丝能够通过的情况下）、保留肾实质的手术。术前必须进行逆行肾盂造影，因为抗结核化疗期间狭窄可能会加重。
