金属支架植入治疗上尿路闭锁的中期结果

目的评价金属支架植入治疗上尿路闭锁的中期疗效。方法1995年10月至1998年12月，采用金属支架永久植入治疗上尿路闭锁患者13例，其中肾盂输尿管连接部闭锁8例，肾下盏输尿管吻合口闭锁3例，输尿管上段闭锁和输尿管膀膀吻合口闭锁各1例。闭锁长度1．0～3．6cm。采用影像学方法定期随访，必要时行输尿管镜检查。结果13例术后随访1～9年，平均92个月。输尿管引流通畅6例，需辅助停留输尿管内支架管、换管时见支架处上皮覆盖完全3例，因肾功能进行性恶化而行肾切除2例，因肾积脓感染无法控制而取出金属支架2例。3例患者分别于置管后4、6、6个月发现支架内肉芽组织生长，用钬激光汽化肉芽组织。其中1例4个月后又出现肉芽组织生长，再用钬激光汽化后长期留置双J管。2例患者于置管术后28、32个月并发支架近端结石，分别用微创经皮取石术和输尿管镜取出。结论金属支架植入治疗上尿路闭锁安全、有效，中期结果满意，其对上尿路动力学的影响尚需进一步研究。

Mid-term results of permanent metallic stent implantation in the treatment of upper urinary tract atresia

Objective To evaluate the mld-term results of permanent metallic stent for the treatment of upper urinary tract atresia. Methods From October 1995 to December 1998, permanent metallic stents were implanted in 13 patients, including 8 cases of ureteropelvlc junction atresia,3 of ureterocalicostomic atresia,1 of upper ureter atresia and 1 of ureteroresicostomotic atresia. Regular imaging studies were performed during follow-up and ureteroscopy was done when needed. Results All the 13 patients had followup for 1 - 9 years with a mean of 92 months. Ureteral patency was achieved in 6 cases and assisted pateney with a double-stent in 3 cases. In 2 cases,the kidneys had to be removed because of progressive malfunction ; and in 2 cases, the metallic stents had to be extracted because of uncontrollable pyonephrosis. Granulation tis- sue growth was found within the stents in 3 cases at 4,6,6 months, respectively, after stentlng; holmium laser vaporization of the granulation tissue was performed. However, it grew again in 1 case after 4 months, then holmium laser vaporization was done again with long-term indwelling double-J tube. Two cases had calculi at the proximal end of the stent at 28 and 32 months, respectively, after implantation. The calculi were taken out via miero-invasive percutaneous lithotomy and ureteroscopy. Conclusions Implantation of metallic stent for upper urinary tract atresia is safe and effective with satisfactory mid-term outcome in selected patients, but its impacts on the urodynamics of upper urinary tract need further investigation.