| 摘要: |
| ［摘要］ 目的 分析输尿管结石合并输尿管远端狭窄采用腔内微创手术治疗的安全性及有效性。方法 回顾性分析2014-01～2019-11该院泌尿外科收治的50例输尿管结石合并输尿管远端狭窄患者的临床资料，术前完善相关检查明确诊断为输尿管结石，采用输尿管硬镜手术，术中发现输尿管远端狭窄输尿管镜无法进镜，采用COOK输尿管扩张器行输尿管狭窄扩张成功后顺利完成手术；狭窄严重扩张失败者留置双J管二期行输尿管硬镜或软镜手术治疗，术后3个月行B超、静脉肾盂造影等检查评估结石清除情况及输尿管通畅情况。结果 50例患者中有36例（72.0%）采用COOK输尿管扩张器扩张输尿管狭窄后一期行输尿管硬镜碎石治疗成功；其余14例采用COOK输尿管扩张器扩张输尿管狭窄失败，输尿管镜无法进镜，放置双J管，根据输尿管狭窄程度，2周到2个月后二期行腔内微创手术治疗，其中7例行输尿管镜气压弹道碎石治疗成功，5例通过输尿管软镜钬激光碎石治疗成功，2例二期行输尿管镜检查发现结石已自行排出。结论 输尿管结石合并输尿管远端狭窄可采用COOK输尿管扩张器扩张后一期输尿管镜碎石，如因输尿管狭窄严重、扩张输尿管后输尿管镜仍进镜困难，放置双J管二期腔内微创碎石，这是一种安全有效的微创治疗方法。 |
| 关键词: 输尿管结石 远端狭窄 腔内微创手术 |
| DOI：10.3969/j.issn.1674-3806.2020.11.15 |
| 分类号:R 693+.4 |
| 基金项目: |
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| Safety and effectiveness of endoluminal minimally invasive surgery for ureteral calculi complicated with distal ureteral stricture |
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WEI Han-ping, JIAO Zhi-min, YUAN Xiao-liang, et al.
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Department of Urology, Changzhou Wujin People′s Hospital, Jiangsu 213002, China
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| Abstract: |
| ［Abstract］ Objective To analyze the safety and effectiveness of endoluminal minimally invasive surgery for ureteral calculi complicated with distal ureteral stricture. Methods The clinical data of 50 patients with ureteral calculi complicated with distal ureteral stricture admitted to the Department of Urology, Changzhou Wujin People′s Hospital from January 2014 to November 2019 were retrospectively analyzed. The diagnosis of ureteral calculi was confirmed by the improved relevant examinations before operation. Rigid ureteroscopy was used. During the operation, it was found that the ureteroscopy could not be carried out due to distal ureteral stricture, and COOK ureteral dilator was used for ureteral stricture expansion and the operation was successfully completed. If the ureteral stricture was serious and ureteral dilatation was unsuccessful, double J tube was placed and two-stage ureteroscopy or flexible ureteroscopy was performed. The patients were reexamined 3 months after the operation, and B-ultrasonography and intravenous pyelography were performed to evaluate the clearance of the calculi and the patency of ureters. Results Thirty-six cases(72.0%) of the 50 patients were successfully treated with rigid ureteroscopic lithotripsy in one stage after ureteral stricture was dilated with COOK ureteral dilator. COOK ureteral dilator failed to dilate the ureteral stricture for the remaining 14 patients and the ureteroscope could not be inserted, and double J tubes were placed. According to the degree of ureteral stricture, two-stage endoluminal minimally invasive surgery was performed 2 weeks to 2 months later. Among them, ureteroscopic pneumatic lithotripsy was successfully performed on 7 cases; flexible ureteroscope holmium laser lithotripsy was successfully performed on 5 cases, and 2 patients underwent ureteroscopy at the second stage and the stones were found to have passed out of the body by itself. Conclusion Ureteroscopic lithotripsy in one stage after dilation of ureteral stricture using COOK ureteral dilator can be used for ureteral calculi complicated with distal ureteral stricture. If the ureteral stricture is serious and the ureteral dilatation is still difficult to access, double J tube is placed and two-stage endoluminal minimally invasive lithotripsy is performed, which is a safe and effective method of minimally invasive treatment. |
| Key words: Ureteral calculi Distal stricture Endoluminal minimally invasive surgery |
