输尿管镜手术上镜困难原因与处理  

Causes and Strategies for the Difficulties in the Ureteroscope Insertion

作　　者：赵利[1] 杨昌勋[1] 王佳兴[1] 

机构地区：[1]湖南省怀化市中医院泌尿外科,怀化418000

出　　处：《中国现代手术学杂志》2011年第1期52-54,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨输尿管镜手术时上镜困难的原因与处理。方法在396例输尿管镜手术患者中,68例(17.2%)发生上镜困难。结果 12例因输尿管结石位于输尿管膀胱壁内段,其中4例用取石钳往上顶,推动结石后进镜成功8,例边碎石边进镜成功。7例输尿管开口狭窄而进镜困难者,放置导管后在其引导下采用旋转镜体、变换进镜角度成功进镜,3例输尿管中、下段狭窄者,经输尿管扩张后,镜体仍上行困难立即改开放手术。41例因输尿管扭曲使镜体上行困难者,采取头低脚高位、调低灌注液压力、更换导管等处理,成功上镜37例;4例反复试插不成功,后改置输尿管导管于结石远端立即行ESWL碎石成功。5例因输尿管结石远端有环形隔膜导致上行困难者,4例经过反复扩张后可顺利上镜,1例虽经扩张后仍无法上行镜体,改置输尿管导管于结石远端立即行ESWL。结论输尿管上镜困难多因结石、狭窄阻塞或输尿管扭曲所致,经导管引导扩张、变换体位及输尿管进镜角度或碎石后多能置镜成功。Objective To analyze the causes and strategies for the difficulties in the ureteroscope insertion.Method In 396 cases of ureteroscopic surgery,68 cases（17.2%） occurred the difficulties of ureteroscope insertion.Results In the 12 ureteral calculi in the ureter at the bladder wall segment,4 calculi were pushed upgradely by the lithotomy forceps,and the other 8 calculi were crushed by ureteroscopic lithotripsy.In the 7 cases of uretero-vesical orifice stricture,the ureteroscope was put successfully by the guidance of the catheter.In the 3 cases of ureteric stenosis at the middle and inferior segment,it was conversed to open surgery after the failure of the dilatation of ureter.In the 41 cases of ureteric distortion,37 cases got success by several interventions such as posture changing,perfusion fluid pressure reduction,catheter replacing,and the other 4 cases changed to ESWL after ureteral catheter insertion.In the 5 cases with circleround septum at the distal end of the stone,4 cases accomplished after dilation,and one changed to ESWL after ureteral catheter insertion.Conclusions Ureteral calculi combined with ureterostenosis and ureteric distortion may be the main reasons of the difficulties in the ureteroscope insertion.It is the key to resolve the difficulties by prehension the main points of operation.

关 键 词：输尿管结石 输尿管镜检查 

分 类 号：R693.4[医药卫生—泌尿科学]