逆行输尿管支架置入术作为急诊复杂急性结石梗阻性尿路病变初始引流方法失败的预测因素

M. Elbaset, M. Edwan, Rasha T. Abouelkhei, Rawdy Ashour, M. Ramez, Abdalla Abdelhamid, Y. Osman
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引用次数: 1

摘要

目的:探讨急性结石梗阻性尿路病变患者需要经皮肾造口术(PCN)引流的初始逆行输尿管支架置入(RUS)失败的预测因素。方法:我们对2016年1月至2020年1月期间出现的复杂阻塞性尿路结石病(急性肾功能衰竭或阻塞性肾盂肾炎)患者进行了回顾性评估。不可见同侧输尿管口及输尿管外源性梗阻者排除。入院时使用非对比计算机断层扫描评估患者人口统计学和影像学资料,包括结石部位、肾积水等级、最大横向结石直径、输尿管周围密度(PUD)和最大横向结石直径处的输尿管周厚度(P-CUT)。结果:研究纳入256例患者,最初采用RUS试验管理。其中48例(18.8%)出现RUS失败。急性肾盂肾炎、最大结石横径≥9.5 mm、P- cut≥7.5 mm、结石水平PUD≥17.5 HU是RUS衰竭的危险因素(P分别为0.007、0.002、< 0.001和< 0.001)。结论:最初的影像学结石和输尿管特征,加上临床诊断为梗阻性肾盂肾炎,可用于确定PCN插入作为泌尿引流的首选方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy
Objective: To define predictors for initial retrograde ureteral stenting (RUS) failure with the need for the percutaneous nephrostomy (PCN) insertion as a drainage method in patients with complicated acute calculus obstructive uropathy. Methods: We undertook a retrospective evaluation of patients who presented with complicated obstructive calculus uropathy (acute renal failure or obstructive pyelonephritis) between January 2016 and January 2020. Patients in whom there was failure to visualize ipsilateral ureteric orifice and those with extrinsic ureteral obstruction were excluded. Patient demographics and radiological data including stone site, hydronephrosis grade, maximum transverse stone diameter, periureteral density (PUD) and pericalcular ureteric thickness (P-CUT) at the maximum transverse stone diameter were assessed using non-contrast computed tomography at the time of admission. Results: The study included 256 patients who were managed initially by RUS trial. Of them, 48 (18.8 %) had RUS failure. The presence of acute pyelonephritis, increased maximum transverse stone diameter ≥ 9.5 mm, P-CUT ≥ 7.5 mm, and PUD at stone level ≥ 17.5 HU were risk factors associated with RUS failure (P = 0.007, 0.002, < 0.001, and < 0.001, respectively). Conclusion: Initial radiological stone and ureteric characteristics, in addition to the clinical diagnosis of obstructive pyelonephritis, can be used to determine PCN insertion as the preferred option over RUS for urinary drainage.
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