Година 13, Издание 1 Издание 1
Оригинална статия / Публикувана: Септември 2025
DOI: https://www.doi.org/10.57045/jemis/1310925.pp11-24
К. Христов1, О. Гъцев1, В. Тодорова1, Д. Петрова2, К.Петкова1, М. Михайлова –Христова3, И. Салтиров1
1Клиника по урология, 2Клиника по нефрология, Катедра по урология и нефрология, Военномедицинска академия, София,България, 3 Клиника по нуклеарна медицина, Специализирана университетска болница за активно лечение на онкологията
Резюме
Лъчетерапията в областта на таза е показана при злокачествени заболявания на шийката на матката, простатата, ректума и стомашно-чревния тракт. Рядък, но известен нежелан ефект от това лечение са радиационно-индуцираните уретерални стриктури (RIUS). RIUS могат да причинят инфекция, хидронефроза, нефролитиаза и в по-напреднали случаи и бъбречна недостатъчност. Лечението на радиационно-индуцираните уретерални стриктури е предизвикателство за уролозите, тъй като такъв тип стриктури са склонни да бъдат дълги, двустранни и с исхемична етиология. Методите на лечение могат да бъдат ендоскопски, отворени и минимално инвазивни техники и поставяне на уретерални стентове и перкутанни нефростоми (PCN). Последните обикновено се използват като временно решение до извършването на дефинитивно лечение, но те могат да бъдат и дългосрочен вариант при пациенти, които не са показани за друг вид хирургично лечение. Балонната дилатация и ендоуретеротомията са показали ефикасност между 60-80 %, но са по-малко ефективни при радиационно-индуцираните уретерални стриктури поради исхемичния характер на заболяването. Уретероуретеростомията е най-подходяща за къси стриктури в средна до проксималната част на уретера. Уретероцистонеостомията е по-подходяща за дълги стриктури в дисталния уретер и може да бъде извършена като псоасна фиксация или по метода на Боари за увеличаване на дължината на участъка за анастомозиране с пикочния мехур. Важно е да се отбележи, че при пациенти подложени на лъчетерапия, фиброзата на пикочния мехур може да бъде противопоказание за тези процедури. Присадките на букална лигавица при уретеропластиката се използват все по-често с процент на успех между 80- 90 %, въпреки че този брой намалява до около 30% при по-дългите стриктури. Заместители на сегменти от уретера със сегмент от черво влизат в съображение при по-дълги стриктури и при пациенти с двустранно заболяване. В скорошни проучвания беше проучена апендикулярната интерпозиция както за десностранни, така и за левостранни стриктури с дължина около 3-5 см с процент на успех около 70%. По- инвазивни техники като трансуретероуретеростомията (TUU) и бъбречната автотрансплантация са показани при изключително дълги или пануретерални стриктури и обикновено са неподходящи за онкоболни пациенти, претърпели лъчетерапия. В обобщение минимално инвазивните подходи, макар и по-малко проучени, са показали сходни клинични резултати и процент на усложнения с по-кратък болничен престой. В този обзорен материал ще бъде обобщена актуалната информацията касаеща съвременното лечение на радиационно индуцираните уретерални стриктури.
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Ключови думи:
радиация, лъчетерапия, уретерална стриктура, радиационно-индуцирана уретерална стриктура
Как да цитирате тази статия:
К. Христов, О. Гъцев, В. Тодорова, Д. Петрова, К.Петкова, М. Михайлова–Христова, И. Салтиров. Обзор на съвременното лечение на радиационно-индуцираните уретерални структури в областта на таза. Ендоурология и минимално инвазивна хирургия, 2025; 13(1):11-24
Адрес за кореспонденция:
Д-р Константин Христов
Военномедицинска академия-София Катедра Урология и нефрология, Клиника по Урология
Бул. „Георги Софийски“3, София 1606
Тел. +359878427317
E-поща: konstantin.hristovv@gmail.com
www.urology-vma.bg