覆膜金属输尿管支架治疗盆腔脂肪增多症所致肾积水的疗效
Efficacy of coated metal ureteral stent in the treatment of pelvic lipomatosis induced hydronephrosis
王明瑞 1王起 1胡浩 1赖金惠 1唐鑫伟 1万春艳 1许克新 1徐涛1
作者信息
- 1. 北京大学人民医院泌尿外科,北京大学应用碎石技术研究所,北京 100044
- 折叠
摘要
探讨留置覆膜金属输尿管支架(coated metal ureteral stent,CMUS)治疗盆腔脂肪增多症所致肾积水(pelvic lipomatosis induced hydronephrosis,PLH)的初步经验.回顾性分析2018年8月至2021年2月北京大学人民医院采用CMUS治疗PLH的8例患者的临床和随访资料.入组标准:影像学证实盆腔内膀胱周围过多的脂肪组织,膀胱抬高呈"倒梨形",膀胱壁增厚;膀胱镜检查提示膀胱黏膜滤泡样增生,活检病理提示腺性膀胱炎;单侧或双侧肾积水和输尿管扩张.排除标准:输尿管闭锁;反复加重的膀胱出口梗阻.记录患者的围手术期资料,其中术前基线资料包括患者年龄、性别、血肌酐、肾盂宽度和输尿管支架症状问卷(ureteric stent symptoms questionnaire,USSQ)评分,术中资料包括逆行尿路造影下观察的输尿管狭窄部位和长度,术后随访资料包括血肌酐、肾盂宽度和USSQ评分.本组8例(11侧)PLH患者全部为男性,平均年龄为(38.7±8.6)岁,单侧肾积水5例和双侧肾积水3例.术前平均血肌酐为(90.0±10.3)μmol/L,平均肾盂宽度为(3.0±1.5)cm,术中发现全部为输尿管下段狭窄,平均狭窄长度为(1.9±0.9)cm.术前有3例患者留置输尿管双猪尾管,USSQ评分分别为97.0、68.0和100.0分.5例患者逆行置入CMUS支架,3例采用顺逆行结合的方式.末次随访时平均血肌酐为(82.0±11.1)μmol/L,较术前显著降低(t=3.23,P=0.02);平均肾盂宽度为(1.9±0.5)cm,较术前显著降低(t=3.12,P=0.02);在术前留置双猪尾管的3例患者中,更换为CMUS后末次随访时USSQ评分分别为87.0、62.0和89.0分,患者症状均较术前改善.平均随访时间为(10.0±6.3)个月,随访过程中1例患者出现CMUS相关症状,未发现支架相关感染、支架结壳等并发症;1例患者在术后3个月支架移位至膀胱,经尿道取出支架后随访3个月,肾积水基本消失.CMUS支架治疗PLH具备一定的有效性和安全性,可以作为PLH长期维持性治疗的新方法.
Abstract
To investigate the initial experience of coated metal ureteral stent(CMUS)for treatment of pelvic lipomatosis induced hydronephrosis(PLH).The clinical and follow-up data of 8 patients who were diagnosed as PLH treated with CMUS in Peking University People's Hospital from August 2018 to February 2021 were retrospectively analyzed.Inclusion criteria included:Imaging evidence of excessive adipose tissue around the bladder in the pelvic cavity,bladder elevation in an"inverted pear shape",and bladder wall thickening;Cystoscopy indicated follicular hyperplasia of bladder mucosa and biopsy pathology indicated glandular cystitis;Unilateral or bilateral hydronephrosis and ureteromegaly.Exclusion criteria included:Ureteral atresia;Recurrent obstruction of the bladder outlet.Preoperative baseline data included age,gender,serum creatinine,pelvis width and ureteric stent symptoms questionnaire(USSQ)score.Intraoperative data included the location and length of ureteral stenosis observed by retrograde urography.Postoperative follow-up data included serum creatinine,pelvis width,and USSQ score.In the study,8 patients(11 sides)with PLH were all male,with an average age of(38.7±8.6)years.Uni-lateral hydronephrosis was found in 5 cases and bilateral hydronephrosis in 3 cases.Preoperative mean serum creatinine was(90.0±10.3)μmol/L,and the mean renal pelvis width was(3.0±1.5)cm.The lower ureteral stricture was found in all cases,and the mean stricture length was(1.9±0.9)cm.Before operation,3 patients had ureteral Double-J stents,with USSQ scores of 97.0,68.0 and 100.0,respectively.Five patients underwent retrograde CMUS stenting,and 3 patients retrograde and antegrade.At the last follow-up,the average serum creatinine was(82.0±11.1)μmol/L and the mean renal pel-vis width was(1.9±0.5)cm,which were significantly lower than those before operation(t=3.12,P=0.02;t=3.23,P=0.02).In the 3 patients with Double-J stent before surgery,the USSQ scores were 87.0,62.0 and 89.0,respectively,which were significantly improved after CMUS stenting.The average follow-up time was(10.0±6.3)months.During the follow-up,1 patient developed CMUS re-lated symptoms,and no stent-associated infection and stent encrustation were found.In one case,the stent migrated to the bladder 3 months after operation,and the hydronephrosis disappeared after 3 months follow-up.CMUS stenting for treatment of PLH has certain efficacy and safety,which can explore a new therapeutic method for the long-term treatment of PLH.
关键词
覆膜金属输尿管支架/盆腔脂肪增多症/肾积水Key words
Coated metal ureteral stent/Pelvic lipomatosis/Hydronephrosis引用本文复制引用
基金项目
首都卫生发展科研专项(2020-2Z-40810)
出版年
2024
国家科技期刊平台
NSTL
万方数据