热膨胀镍钛合金输尿管支架置入维持性治疗输尿管狭窄的疗效

doi:10.19723/j.issn.1671-167X.2026.04.020

摘要/Abstract

摘要：

目的: 评估热膨胀镍钛合金输尿管支架[梅莫凯斯(Memokath)-051型]维持性治疗输尿管狭窄的临床疗效及安全性。方法: 回顾性分析2024年1月至2025年4月北京老年医院收治的16例输尿管狭窄患者的临床资料，其中男性3例，女性13例，平均年龄(57.60±9.79)岁。病因分布：腹盆腔肿瘤放疗术后13例，腹膜后纤维化2例，输尿管肉芽肿1例。16例患者均为双J管留置失效后改行热膨胀镍钛合金输尿管支架置入，其中7例为双侧输尿管病变，共置入23侧输尿管支架。记录手术时间、并发症(采用Clavien-Dindo分级)、支架通畅率及输尿管支架症状问卷(ureteral stent symptom questionnaire, USSQ)评分，随访术后3、6、12个月的血肌酐及肾积水改善情况。结果: 23侧支架均成功置入(成功率100%)，手术平均时长(51.52±9.55) min，术后12个月支架总体通畅率为82.61%(19/23)。早期并发症7例；长期并发症4例，包括支架移位1例、组织增生堵塞2例、结石堵塞1例；余5例无并发症发生。术后3个月血肌酐由术前186.80 (111.80, 244.93) μmol/L降至103.05 (96.20, 135.97) μmol/L(P < 0.01)，肾积水宽度由3.20 (2.78, 3.40) cm降至2.05 (1.08, 2.20) cm (P < 0.01)，术后6、12个月血肌酐及肾积水保持稳定。与术前留置双J管相比，USSQ中泌尿系统症状(34.75±2.34 vs. 23.75±3.26)、躯体疼痛(6.50±2.26 vs. 3.00±1.22)、健康状况及工作情况的评分均显著改善(均P < 0.001)。结论: 热膨胀镍钛合金输尿管支架(梅莫凯斯-051型)置入维持性治疗输尿管狭窄安全有效，相较于双J管，可改善肾功能及肾积水，提高患者生活质量，尤其适用于放疗后等病因导致的长段输尿管狭窄患者。

关键词: 输尿管狭窄, 输尿管支架, 热膨胀, 镍钛合金, 微创治疗

Abstract:

Objective: To evaluate the clinical efficacy and safety of thermo-expandable nickel-titanium alloy ureteral stents (Memokath-051) for maintenance therapy of ureteral strictures. Methods: A retrospective analysis was conducted on the clinical data of 16 patients with ureteral strictures admitted to Beijing Geriatric Hospital from January 2024 to April 2025. The cohort comprised 3 males and 13 females, with a mean age of (57.60±9.79) years. Etiologies included post-radiation stricture following abdominopelvic tumor radiotherapy in 13 patients, retroperitoneal fibrosis in 2, and ureteral granuloma in 1. All the 16 patients had experienced failure of previous indwelling double-J stent placement and subsequently underwent conversion to thermo-expandable nickel-titanium alloy ureteral stent insertion. Among the 16 patients, 7 had bilateral ureteral lesions, with a total of 23 ureteral units treated. Operative time, complications (graded according to the Clavien-Dindo classification), stent patency rate, and ureteral stent symptom questionnaire (USSQ) scores were recorded. Follow-up assessments of serum creatinine levels and hydronephrosis improvement were performed 3, 6, and 12 months postoperatively. Results: All 23 stents were successfully placed in the 16 patients (technical success rate, 100%), with a mean operative time of (51.52±9.55) min. The overall stent patency rate 12 months postoperatively was 82.61% (19/23). Early complications occurred in 7 patients. Long-term complications developed in 4 patients, including stent migration (n=1), tissue hyperplasia-induced obstruction (n=2), and stone-related obstruction (n=1); the remaining 5 patients had no complications. Three months postoperatively, serum creatinine decreased from the preoperative baseline of 186.80 (111.80, 244.93) μmol/L to 103.05 (96.20, 135.97) μmol/L (P < 0.01), and hydronephrosis width decreased from 3.20 (2.78, 3.40) cm to 2.05 (1.08, 2.20) cm (P < 0.01). Serum creatinine levels and hydronephrosis remained stable 6 and 12 months postoperatively. Compared with the previous indwelling period of double-J stents, USSQ scores showed significant improvements in urinary symptoms (34.75±2.34 vs. 23.75±3.26), bodily pain (6.50±2.26 vs. 3.00±1.22), general health status, and work performance (all P < 0.001). Conclusion: Placement of thermo-expandable nickel-titanium alloy ureteral stents (Memokath-051) as maintenance therapy for ureteral strictures is safe and effective. Compared with double-J stenting, it improves renal function and hydronephrosis, and enhances patient quality of life. This approach is particularly applicable to patients with long-segment ureteral strictures secondary to post-radiation etiologies.

Key words: Ureteral stricture, Ureteral stent, Thermal-expansion, Nitinol, Minimally invasive therapy

中图分类号:

R693.2

陈国卫, 谢遵珂, 师磊, 郭学敬, 王俊欣, 曹犇, 胡浩, 晋连超. 热膨胀镍钛合金输尿管支架置入维持性治疗输尿管狭窄的疗效[J]. 北京大学学报（医学版）, 2026, 58(4): 827-832.

Guowei CHEN, Zunke XIE, Lei SHI, Xuejing GUO, Junxin WANG, Ben CAO, Hao HU, Lianchao JIN. Efficacy of thermo-expandable nickel-titanium alloy ureteral stent placement as maintenance therapy for ureteral strictures[J]. Journal of Peking University (Health Sciences), 2026, 58(4): 827-832.

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参考文献 16

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Case No.	Gender	Age/years	Laterality	Pathogenesis	Double J stent duration/months
1	F	56	Bilateral	Retroperitoneal fibrosis	24
2	F	46	Left	Radiotherapy after cervical cancer surgery	15
3	F	55	Bilateral	Radiotherapy after cervical cancer surgery	20
4	F	53	Left	Immune-related ureteral granuloma	19
5	F	67	Bilateral	Radiotherapy after cervical cancer surgery	3
6	F	52	Left	Radiotherapy after cervical cancer surgery	20
7	F	71	Bilateral	Radiotherapy after cervical cancer surgery	60
8	M	67	Left	Radiotherapy after colon cancer surgery	12
9	M	65	Right	Chemoradiation for ureteral carcinoma	4
10	F	30	Bilateral	Radiotherapy after cervical cancer surgery	2
11	F	62	Bilateral	Radiotherapy after cervical cancer surgery	36
12	F	63	Right	Radiotherapy after cervical cancer surgery	19
13	F	61	Right	Chemoradiotherapy after cervical cancer surgery	20
14	F	57	Bilateral	Chemoradiotherapy after cervical cancer surgery	8
15	F	62	Right	Radiotherapy after cervical cancer surgery	54
16	M	66	Left	Retroperitoneal fibrosis	10

Patients	Stents	Length/cm	Complication	Clavien-Dindo grade	Management
1	1	15	Occlusion	Ⅲ	Double J stenting in lumen (2 weeks)
1	2	20	Occlusion	Ⅲ	Double J stenting in lumen (2 weeks)
2	3	25	None
3	4	15	Pain	Ⅰ	Analgesics
3	5	10	None
4	6	15	Migration	Ⅲ	Stent replacement
5	7	20	None
5	8	20	None
6	9	15	Stone obstruction	Ⅲ	Stent replacement
7	10	20	Tissue obstruction	Ⅲ	Stent replacement
8	11	10	Tissue obstruction	Ⅲ	Stent replacement
8	12	20	None
9	13	15	None
10	14	25	Fever	Ⅱ	Antibiotics
10	15	15	Fever	Ⅱ	Antibiotics
11	16	20	None
11	17	20	Pain	Ⅰ	Analgesics
12	18	25	None
13	19	25	None
14	20	15	Pain	Ⅰ	Analgesics
14	21	20	None
15	22	25	Pain	Ⅰ	Analgesics
16	23	25	Pain	Ⅰ	Analgesics

Items	Preoperative	3 months postoperatively	6 months postoperatively	12 months postoperatively	χ²	P
Scr/(μmol/L), M (P₂₅, P₇₅)	186.80 (111.80, 244.93)	103.05 (96.20, 135.97)	97.45 (87.18, 124.50)	105.90 (87.08, 126.45)	19.50	＜0.01
Width of hydronephrosis/cm, M (P₂₅, P₇₅)	3.20 (2.78, 3.40)	2.05 (1.08, 2.20)	1.98 (1.08, 2.10)	1.69 (1.23, 2.30)	27.94	＜0.01

USSQ domain	Preoperative	3 months postoperatively	t	P
Urinary symptoms	34.75±2.34	23.75±3.26	11.10	＜0.001
Physical pain	6.50±2.26	3.00±1.22	5.27	＜0.001
General health status	14.19±1.52	9.37±2.09	7.24	＜0.001
Work performance	9.06±1.18	4.44±1.09	10.58	＜0.001