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中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 463 -467. doi: 10.3877/cma.j.issn.1674-3253.2022.05.020

综述

输尿管镜碎石术后留置输尿管支架的必要性探讨
马涛1, 叶春伟1, 李志鹏1,()   
  1. 1. 650101 云南,昆明医科大学第二附属医院泌尿外科
  • 收稿日期:2021-04-16 出版日期:2022-10-01
  • 通信作者: 李志鹏
  • 基金资助:
    国家自然科学基金项目(82060533)

Discussion on the necessity of indwelling ureteral stent after ureteroscopic lithotripsy

Tao Ma1, Chunwei Ye1, Zhipeng Li1()   

  • Received:2021-04-16 Published:2022-10-01
  • Corresponding author: Zhipeng Li
引用本文:

马涛, 叶春伟, 李志鹏. 输尿管镜碎石术后留置输尿管支架的必要性探讨[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(05): 463-467.

Tao Ma, Chunwei Ye, Zhipeng Li. Discussion on the necessity of indwelling ureteral stent after ureteroscopic lithotripsy[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(05): 463-467.

尿石症是最常见的泌尿外科疾病,患病率为10%~15%,复发率为50%[1]。在发展中国家或发达国家,这一比例更显著,且在过去20年增长了37%以上[2]。输尿管结石通常会引起输尿管阻塞、肾绞痛、尿路感染和肾积水等并发症。输尿管镜碎石取石术(ureteroscopic lithotripsy,URL)是去除输尿管结石应用最广泛的技术之一,成功率较高[3]。输尿管支架通常在输尿管结石手术中使用,其主要优点是便于碎石通过,防止输尿管阻塞及狭窄[4]。然而,考虑到支架引起的相关并发症,包括刺激、不适,以及支架滞留所引起的支架迁移,膀胱输尿管反流和支架结垢等风险,使用输尿管支架治疗输尿管结石仍然存在争议[56]。目前输尿管镜碎石术后常规留置输尿管支架是否有意义一直是临床研究的焦点之一。一些学者认为,输尿管支架具有引流和内支架的双重作用,可有效解除上尿路梗阻的同时缓解肾绞痛症状并保护患肾功能[7]。但也有一些学者持相反意见,约有9.1%的输尿管支架留置患者肾积水并没有明显改善,且5.4%的肾积水患者甚至比置管前更加严重[8]。有学者更是在其文章中指出,留置输尿管支架后,部分患者肾积水不但不能得到改善,而且肾功能会继续受到损害,不利于保护肾功能[9]。现阶段许多术者主要担心发生输尿管狭窄而在URL术后常规留置输尿管支架[10],但术后是否有必要留置输尿管支架仍是泌尿外科医师需要关注思考的问题,本文就此内容进行综述。

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