三导丝法逆行支架置人术在输尿管下段黏膜袖套样撕脱中的应用，

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Application of the three-guidewire technique in retrograde stent placement for mucosal sleeve avulsion of the lower ureter

DONG Hongchao，HAO Yu，NI Zhao，WANG Qinzhang （Department of Urology，The First Affiliated Hospital of Shihezi University，Shihezi 832O08，China）

ABSTRACT：ObjectiveTo evaluate the feasibilityandeficacyof thethre-guidewire technique for retrograde stent placement in the treatment of ureteral mucosal sleeve avulsion（UMSA）.MethodsAretrospective analysis wasconducted on theclinicaldataof12patients withUMSAsecondarytoureteroscopiclithotripsyforureteralcalculi inour hospitalduringJul. 2010 and Oct. 2023.The thre-guidewire technique was employed for retrograde stent placement during the procedure.A secondaryureteroscopic lithotripsy was performedone month postoperatively.ResultsDouble-Jstent was successull placed in all l2 patients，with a mean stent insertion time of 23.3（16-30） ）minutes. No intraoperative exacerbation of mucosal avulsion occurred.One patient was lost to folow-up.At the one-month postoperative ureteroscopic examination and lithotripsy， 81.8% （9/11） cases exhibited unobstructed ureters，while 18.2%（2/11） ）developed annular membranous strictures， which wereresolved following dilation.Duringsubsequent folow-up，thepostoperative creatinine levelafterdouble-Jstent removal showed a mild decrease compared to the preoperative level [87.9（72—100） μmol/L vs. 90.1（69-108）μmol/L] .Up to 90.9%（10/11 ）patients remained free of hydronephrosis，with only 1 case （9.1% ）requiring laparoscopic ureterovesical reimplantation for hydronephrosis 4months postoperatively.ConclusionThe thre-guidewire technique forretrograde stent placement inthe treatmentof UMSA demonstratesstrong operability，high successrates，favorableoutcomes，andalow incidence of ureteral stricture，which warrant wide clinical promotion.

KEYWORDS：surgical technique;ureteral injury;ureteral mucosal sleve avulsion；catheterization;ureteroscope;uretera stricture;three-guidewire technique

摘要：目的探讨三导丝法逆行输尿管支架置人术治疗输尿管黏膜袖套样撕脱（UMSA）的可行性及疗效。（剩余8313字）