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输尿管支架的放置与管理

Authors
Stephen Nakada, MD
Sutchin Patel, MD
Section Editor
Jerome P Richie, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
陈合群, 主任医师，教授

引言

输尿管支架是泌尿外科医生最常使用的一种器材，通常是在手术室中在膀胱镜引导下进行放置。输尿管支架可用于解除输尿管梗阻、促进术后输尿管愈合，以及在盆腔手术中协助识别输尿管。输尿管支架放置在大多数患者中可引起一定程度的并发症，从一般的泌尿不适至泌尿道感染或梗阻。多数并发症与支架材料的生物相容性有关，某种程度上也与支架的设计有关。遗憾的是理想的输尿管支架尚未出现。

本专题将讨论输尿管支架置入的适应证、输尿管支架置入的技术、支架的管理及其相关并发症。泌尿道梗阻和泌尿道感染的处理将在别处详细讨论。 (参见“尿路梗阻和肾积水的临床表现和诊断”和“成人尿路感染诊断的排尿取样及评估”)

输尿管支架置入的适应证

输尿管支架的功用是重建或维持输尿管的通畅性。输尿管支架可使输尿管被动扩张，尿液从中空的支架或支架周围流出，从而可促进尿液中碎屑的排出[1,2]。输尿管支架的置入最初会增加输尿管的蠕动，但是随着留置时间的增加，输尿管蠕动的频率和幅度会下降[3-5]。输尿管支架置入的适应证包括如下：

输尿管梗阻 — 肾结石、肿瘤或腹膜后纤维化所致的输尿管梗阻可为单纯性，但也可并发泌尿道感染、肾功能不全或肾衰竭。对于复杂性梗阻的患者，需要及时通过放置输尿管支架或放置经皮肾穿刺造瘘管进行泌尿道减压[6-8]。逆行性输尿管支架置入或者经皮肾穿刺造瘘术均能有效地缓解输尿管结石所致的梗阻和感染。两项比较这两种治疗方式的随机试验显示，在引流尿液后促进更快恢复方面，这两种方式无差异[9,10]。泌尿道梗阻的处理将在别处详细讨论。 (参见“尿路梗阻和肾积水的临床表现和诊断”和“输尿管结石的治疗”)

通常首选输尿管支架以帮助缓解泌尿道梗阻，因为与经皮肾穿刺造瘘管放置相比，其侵入性更小且出血风险更低。然而，对于在内镜引导下无法放置输尿管支架、或将需要做进一步的经皮治疗结石的患者，则首选放置经皮肾穿刺造瘘管。

                              

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-17.
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