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目的探讨经皮肾镜顺行放置双J管治疗复杂输尿管狭窄的临床疗效。方法对7例逆行置管失败的患者经超声引导下行肾盂穿刺,将肾镜置入肾盂内,在C臂X光监视下顺行置入斑马导丝,沿导丝放置双J管,术后观察其临床疗效。结果本组7例中,1例双侧(宫颈癌)和1例单侧(回肠膀胱)狭窄患者因导丝不能通过狭窄处双J管放置失败。其余3例双侧狭窄、2例单侧狭窄患者均成功放置双J管,成功置管患者中3例(回肠膀胱)拔除支架管后症状好转,血肌酐下降及肾积水保持稳定,随访时间3-9个月(平均6个月),另外2例(宫颈癌术后)拔除支架管后1-3个月,血肌酐进行性上升,予以再次留置双J管并定期更换。结论经皮肾镜顺行放置双J管治疗复杂输尿管狭窄,可以逆转输尿管梗阻引起的肾功能衰竭,是一种安全有效的、微创方法 ,值得临床推广。
Objective To investigate the clinical effect of percutaneous nephrolithotomy on double J tube in the treatment of complex ureteral stricture. Methods Seven patients with failed retrograde catheterization underwent ultrasound-guided pelvic puncture. The nephrolithotomy was placed in the renal pelvis. A zebra guidewire was placed on the C-arm X-ray and a double J tube was placed along the guidewire. Observe its clinical efficacy. Results In this group of 7 patients, one case of bilateral (cervical cancer) and one case of unilateral (ileum bladder) stenosis failed because the guide wire could not pass through the double J tube in the stenosis. The remaining 3 patients with bilateral stenosis and 2 patients with unilateral stenosis were successfully placed double J tube, 3 patients (ileum bladder) successfully inserted the stent tube in the successful management of the symptoms improved, decreased serum creatinine and hydronephrosis remained stable, follow-up time 3-9 months (average 6 months), and the other 2 cases (cervical cancer after surgery) 1-3 months after removal of stent-graft, serum creatinine increased progressively, to be double-J tube again and replace the regular replacement. Conclusion Percutaneous nephrolithotomy placed double J tube in the treatment of complex ureteral strictures can reverse the renal failure caused by ureteral obstruction, which is a safe and effective, minimally invasive method, which is worthy of clinical promotion.