2023年全國碩士研究生考試考研英語一試題真題（含答案詳解+作文范文）_第1頁
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1、WldJUrolDOI10.1007s0034500802454123IGINALARTICLEInitialclinicalexperiencewithfulllengthmetalureteralstentsfobstructiveureteralstenosisUdoNageleMarkusA.KuczykMarcusHstmannJrgHennenlotterKarlDietrichSievertDavidSchillingUt

2、eWalcherArnulfStenzlAristotelisG.AnastasiadisReceived:11October2007Accepted:13February2008?SpringerVerlag2008AbstractObjectivesLongtermureteralstentingisusedtoensureurinarydrainageifareconstructiveapproachareleaseofanext

3、rinsicobstructionisnotpossible.Inthiscontributionalongtermexperiencewithanewfulllengthmetalindwellingstentispresented.MethodsFourteenpatientswithureteralobstructionreceivedfullmetalindwellingstentsin18collectingsystems(b

4、enigndiseasein5malignantdiseasein13).StentplacementwasperfmedcystoscopicallyunderXuoroscopicguidance.Followupwasdoneevery3monthswithultrasonographicexaminationcreatininelevelsavisualanalogpainsce.ResultsEightstentswerere

5、movedwhereaseightarestillinsitu.Onepatientwithoutstentrelatedproblemsdiedbecauseofprogressiverectalcancer9monthsafterbilateralstention.Meanstentduration(8stentsstillinsitu)is8.6monthswhereasmeanstentdurationfbenignmalign

6、antdiseaseis11.8(median13)7.3(median6)monthsrespectively(p0.05).Allremovedstentswereextractedendoscopicallywithoutanyproblemshadnoincrustationexcepttwo.Neithermigrationnmechanicaldamagewasobserved.ConclusionThisnovelsten

7、tiseasytoremove.Itisanoptionfpatientsinwhichasurgicalreconstructionoftheobstructedureterisnotpossible.Stentshavebeendevelopedfurtherarenowavailableinvariouslengths.Thismightresultinareductionofproblemsassociatedwithinade

8、quatestentlengthshouldincreasepatientcomftstentdurability.KeywdsUreteralobstructionEndourologyMetalstentIntroductionTheaimoflongtermureteralstentinginthecaseofobstructionoftheupperurinarytractistoensureurinarydrainagefro

9、mthekidneytothebladderifareconstructiveapproachcannotbeachievedduetopatientstatusifareleaseofanextrinsicobstructionisnotpossiblebymedicalinterventionaltreatments.Howeverthelongtermfailurerateofindwellingureteralstentsish

10、igh[12].Ontheotherhplacementofanephrostomytubedecreasesqualityoflifeisapossibleentrysitefbacteriatherefeapossiblesourceofinfection.Thelattershouldbeavoidedespeciallyinpatientsundergoingchemoimmunotherapy.Variousexpablesh

11、tmetalstentshavebeenusedwithinthelastdecade.ExactplacementbiocompatibilityaswellasWnancialissuesareongoingmattersofdebateregardingcomftfeasibilityofthisfmofurinarydrainage[3].Inthiscontributionaninitialclinicalexperience

12、withafulllengthmetalindwellingstentispresentedf14patients.MaterialsmethodsPatientrecruitmentacteristicsBetween6May20053November200514patientswithureteralobstructionreceivedfullmetalindwellingU.Nagele(rldJUrol123edintothe

13、introducersheathplacedintheureterunderradiologicalcontrolusingapusher(Fig.2)(PollackcatheterFEPintroducersheathpusherstentfromResonanceStentSetCookIrelLtdLimerickIrel).Insomemalepatientstheiginalintroducersetwastooshttop

14、lacethestentcrectly.Inthesecasesa9Fr.accesssheath(FlexCookIrelLtd.LimerickIrel)wasusedtoplacethestent.Inonecasearetrogradepyelographycouldnotbeperfmed.Aftersonographicallyguidedpunctureofthekidneyfollowedbyantegradepyelo

15、graphytheguidewirewasplacedantegradely.Afterharvestingtheguidewireretrogradelythestentwasplacedinthesamewayasdescribedpreviously.Costcomparison(eg.fanesthesiateammaterials)betweenionexchangeofnephrostomytubeindwellingdou

16、blejstentresonancestentispresentedinTable3.FollowupInallpatientssonographicalevaluationofhydronephrosisaswellasurinecreatinineexaminationwasperfmed.Voidingdisdersaswellasavisualanalogpainscewerereptedbythepatientsevery3m

17、onths.Incaseofseverepatientcomplaintsrecurrentobstructionthestentwasremovedeasilyusingcystoscopyfceps.StatisticalanalysisCrelationsofstentdurationswithseveralclinicalvariableslikethepresenceofbenignversusmalignantdisease

18、apresentstatusafterradiationtherapywereassessedwiththeWilcoxonKruskal–Wallistestcrelationsofpainscestostentdurationswereassessedbyalinearregressionanalysispvalues0.05wereconsideredsigniWcant.Avisualanalogscale(0–5)wasuse

19、dtoratepatientdiscomftpain(0=none5=wstpossible).ResultsFollowuptimewasupto16months(Table2).Onepatientdiedbecauseofprogressiverectalcancer9monthsafterbilateralstention.Howeverhehadnotreptedanystentrelatedproblems.Fromallo

20、therpatientseightstentswereremovedwhereaseightarestillinsitu.Meanstentdurationuntilnow(8stentsstillinsitu)was8.6(median9)months.Inthefourpatientswithbenigndiseaseonestentwasremovedinatransplantedkidneyduetorecurrenturina

21、rytractinfections.Theremainingfourstents(onepatientwithbilateralstents)wereleftinplacewithoutpatientcomplaintsuneventfulfollowup.Sevenstentshadtoberemovedfrom10patients(3withbilateralstents)withmalignantdisease.Theindica

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