【作者】 尹君； 靳雪广； 罗军； 杨奎； 唐启耀；

【Author】 Yin Jun Jin Xue-guang Luo Jun Yang Kui Tang Qi-yao Xin yang city center hospital,Department of interventional Radiology 464000

【机构】 信阳市中心医院介入放射科；

【摘要】 目的评价介入技术——经皮穿刺肾造瘘与顺行性输尿管内支架管植入术在泌尿系梗阻与肾盂输尿管瘘疾病中的临床应用价值。材料和方法不适于外科手术的27例泌尿系良、恶性梗阻患者和3 例肾盂与输尿管瘘的成人患者,在超声和 X-线双监视下采取一步法 Seldinger 技术行肾盂穿刺,根据术中造影表现、梗阻处探通情况和治疗目的的不同行肾造瘘外引流管植入术及/或输尿管内支架管植入术, 观察术中造影表现、术后患者临床症状缓解、肾功能改善、肾小球滤过率恢复和肾盂分离恢复程度及并发症的发生情况。结果造影表现：泌尿系慢性梗阻者可见肾盂、肾盏及近侧段输尿管有不同程度扩张, 梗阻位置呈盲端改变或造影剂细线状通过,膀胱侵犯者膀胱轮廓呈不规则充盈缺损改变；急性梗阻者肾盂与输尿管无扩张或呈轻度扩张；肾盂输尿管瘘者可见病变位置造影剂外溢。操作技术成功率为100%, 共植入外引流管30条,内支架管15条；术后患者临床症状迅速缓解：1～2周内患者腰部胀疼、发热消失,食欲明显改善,12例患者在术后1～2周成功接受开放性手术；3例肾盂输尿管瘘者带管2～3 周痊愈后拔管：长期带管者3月后血 CR 与 BUN 值均显著下降(11例,分别为812．5±381．0μmol,30．0±7．2 mmol),与术前(分别为136．0±55．2μmol,8．4±2．4μmol)比较有显著性差异(P 均＜0．01)；B 超表现肾盂分离程度显著减轻(24肾单元,术前、术后分别为1．8±0．3 cm,4．1+1．3 cm,P＜0．01)：GFR 值显著升高(24肾单元,术前、术后分别为42．8±6．4 mL/min,20．0±6．2 mL/min,P＜0．01)。普通并发症的发生率为30%,为引流或排出尿液少量出血、低热、引流管移位与脱落及输尿管走行区刺激不适感, 无大出血、败血症及周围脏器损伤等严重并发症的发生。结论经皮穿刺肾造瘘和输尿管内支架管植入术具有微创、疗效显著、适应症宽、并发症少、等优点,可为外科手术前期治疗为其提供帮助或作为独立手段达到解除梗阻、引流尿液的治疗目的,值得在复杂性泌尿系梗阻与肾盂输尿管瘘疾病中推广应用。更多还原

【Abstract】 Objective To evaluate the clinic value of percutaneous nephrostomy(PCN)and antegrade internal ureteral stenting(AIUS)to urinary tract obstruction and fistula.Materials and Methods 27 cases of patients with urinary tract obstruction which be unfit for surgery,and 3 cases with fistula in kidney pelvis or ureter,underwent PCN or AIUS.Observed index were followed as:urinary tract demonstration,clinic symptoms alleviating,improvement of renal function,recovery of G lomerular Filtration Rate(GFR)and hydronephrosis,incidence of complications.Results In patients with acute obstruction urinary tract structures above obstruction were significantly dilatated,in chronic obstruction were slightly dilatated,and in fistula contrast were noted overbrim out of urinary tract.Technic success rate was 100%,30 single J tube and double J stent were implanted in PCN and AIUS respectively.One to two weeks after intervention,patients’ clinic symptoms were rapidly alleviated,12 of 27 cases of patients with obstruction received surgery.3 cases of fistula were cured after 2 to 3 weeks.In patients with tube or stent long term,3 months after intervention renal function(n=11 cases),hydronephrosis(n=24 renal units),and GFR(n=24 renal units)all were significant improved(all P＜0.01).Minor complications incidence was 30%,NO severe complications occurred. Conclusions PCN and AIUS bear merits such as microinvasion security,high efficiency and wide indications, can effectively help surgery or independently relieve urinary tract obstruction,deserve generalized in complicated urinary tract obstruction and fistula.更多还原