Wolf J S, Elashry O M, Clayman R V
Section of Urology, University of Michigan, Ann Arbor, USA.
J Urol. 1997 Sep;158(3 Pt 1):759-64. doi: 10.1097/00005392-199709000-00016.
We reviewed the results of endoureterotomy for benign ureteral and ureteroenteric strictures to determine efficacy and factors associated with a successful outcome.
Followup was available for 69 patients undergoing 77 endoureterotomies. Success was defined as symptomatic improvement and radiographic resolution of obstruction. Kaplan-Meier survival curves were constructed and data were analyzed with a Cox proportional hazards model.
None of 9 procedures in patients with the ipsilateral kidney contributing less than 25% of total renal function was successful. Among the 38 remaining benign ureteral stricture treatments with ipsilateral function 25% or greater with a median followup of 28.4 months among successful cases the 3-year success rate was 80%. No procedure failed beyond 11 months and there were 25 patients at risk beyond this point. Among the 30 remaining ureteroenteric stricture treatments with ipsilateral function 25% or greater the success rates at 1, 2 and 3 years were 73, 51 and 32%, respectively. Failures were noted during the first 36 months but none occurred later and 5 patients were at risk beyond this point. Overall, complete or tight strictures were less successfully treated. A nonischemic etiology, a stent 12F or greater and injection of triamcinolone into the bed of the incised stricture were associated with better outcome for strictures longer than 1 cm.
Endoureterotomy of benign ureteral strictures is associated with an excellent outcome (80% success at 3 years). Endoscopic treatment of ureteroenteric strictures is less successful but still offers a reasonable first step (32% 3-year success rate). For all strictures failure is likely if ipsilateral renal function is poor. For strictures longer than 1 cm. use of a stent 12F or greater and injection of triamcinolone appear to be beneficial.
我们回顾性分析了内镜下输尿管切开术治疗良性输尿管及输尿管肠吻合口狭窄的结果，以确定其疗效及与成功结局相关的因素。
对69例行77次内镜下输尿管切开术的患者进行随访。成功定义为症状改善及梗阻的影像学表现消失。构建Kaplan-Meier生存曲线，并采用Cox比例风险模型分析数据。
同侧肾功能占总肾功能不足25%的患者，9例手术均未成功。其余38例同侧肾功能25%或更高的良性输尿管狭窄治疗中，成功病例的中位随访时间为28.4个月，3年成功率为80%。11个月后无手术失败病例，此后有25例患者仍有风险。其余30例同侧肾功能25%或更高的输尿管肠吻合口狭窄治疗中，1年、2年和3年的成功率分别为73%、51%和32%。失败发生在最初36个月内，此后无失败病例，此后有5例患者仍有风险。总体而言，完全性或致密性狭窄的治疗成功率较低。非缺血性病因、12F或更大尺寸的支架以及向切开狭窄部位注射曲安奈德与长度超过1 cm的狭窄的更好结局相关。
良性输尿管狭窄的内镜下输尿管切开术疗效良好（3年成功率80%）。输尿管肠吻合口狭窄的内镜治疗成功率较低，但仍是合理的第一步（3年成功率32%）。对于所有狭窄，如果同侧肾功能差，手术可能失败。对于长度超过1 cm的狭窄，使用12F或更大尺寸的支架及注射曲安奈德似乎有益。
