硬输尿管镜术并发症及其防治  

Treatment and prevention of complication of rigid ureteroscopy

作　　者：蒋雷鸣[1] 杨燕伟[1] 蔡学明[1] 张天禹[1] 覃展偶[1] 曾宪华[1] 李勇平[1] 葛波[1] 

机构地区：[1]桂林医学院附属医院泌尿外科,广西桂林541001

出　　处：《中国内镜杂志》2005年第8期843-845,848,共4页China Journal of Endoscopy

摘　　要：目的探讨硬输尿管镜术并发症发生的原因和防治措施。方法对804例输尿管镜术中发生的并发症进行了回顾性研究。结果1994年10月前后入镜成功率分别67.07%和96.68%。输尿管口撕裂假道形成12例(1.49%)、浅层撕裂47例(5.85%),无输尿管断裂及黏膜撕脱、输尿管穿孔14例(1.74%)、输尿管嵌顿7例(0.87%),术中因出血中止手术10例(1.24%),术后524例获得随访,输尿管口狭窄5例(0.95%),输尿管狭窄8例(1.53%)。中转开放手术2例。术后行ESWL96例,第2次输尿管镜术47例,输尿管气囊扩张7例,输尿管口再植术2例,输尿管端端吻合术4例。该组所有并发症患者经过处理后均得到治愈和明显改善。结论对于严重输尿管镜术并发症应高度重视,采用正确的方法,大部分并发症是可以防治的。[Objective] To study the cause and prevention of complication of rigid ureteroscopy. [Methods] Between October 1991 and June 2004, 804 patients were performed ureteroscopy, A retrospective review of complications with those patients was conducted, [Results] Injured to ureteral orific happened in 59 cases, severe avulsion of ureteral orific in 12 cases （1.49%）, ureteral perforation in 14 cases （1.74%）, Ureteral perforation in 14 cases （1.74%）, incarcerated ureteroscope in 7 cases （0.87%）, homorrhage in 10 cases （1,24%）, Severe avulsion of ureteral menberane not happened in those patients, transform operation needed in 2 cases. ESWL was needed in 96 cases, secondary ureteroscopy in 47 cases after first uretemscopy. Followup imaging with renal ultrosound and excretory urography at 3 months to 23 months after ureteroscopic procedure was available in 524 cases and showed ureteral orific delayed stricture in 5 cases （0.95%）, ureteral stricture in 8 cases （1.53%）. Balloon dilation of ureteral stricture was operated, ureterovesial anastomosis in 2 cases, ureter-ureteral anastomosis in 4 cases. All patients with complication were cured or improved by different means. [Conclusions] We must pay great attention to severe complication of ureteroscopy. Most complication of ureteroscopy can be prevented with correct methods.

关 键 词：输尿管镜术 并发症 治疗 预防 

分 类 号：R693[医药卫生—泌尿科学]