输尿管镜操作技巧及医源性损伤的临床分析(附372例报告)  

To analysis of etiology,treatment and prevention of iatrogenic ureteroscopic injury(report of 372 cases)

作　　者：潘炜[1,2] 张毅[1,2] 庄红雨[3] 姜永光[3] 李明川[3] 张勇[1,2] 

机构地区：[1]江汉大学附属第三医院 [2]武汉市黄陂区人民医院泌尿外科,武汉430000 [3]首都医科大学附属安贞医院泌尿外科

出　　处：《临床泌尿外科杂志》2012年第1期54-56,共3页Journal of Clinical Urology

摘　　要：目的:分析输尿管镜医原性损伤的原因、治疗和预防措施。方法:回顾两家医院自2007年1月～2009年8月所行的372例输尿管镜手术,男141例,女231例;年龄15～87岁,中位年龄42岁;输尿管镜结合钬激光碎石267例;输尿管镜检查术83例;输尿管镜下输尿管狭窄内切开术10例;输尿管镜下放置双J管9例;输尿管镜下拔出双J管3例。结果:发生输尿管损伤有18例(4.8%)。其中,输尿管口严重撕裂2例(11.1%),输尿管穿孔9例(50%),假道形成4例(22.2%),输尿管断裂2例(11.1%),输尿管全层撕脱1例(5.5%)。留置双J管保守治疗13例,开放手术5例。随访3个月～1年,2例轻度肾盂积水,其余病例恢复良好。结论:严格把握输尿管镜手术适应证,不断提高操作技巧可减少对输尿管医原性损伤,及时发现并妥善处理可明显改善患者预后。Objective： To investigate the cause of iatrogenic injury of ureter, and improve the procedures of treatment or prevention. Method： The operational data were retrospective analized in 372 patients with uretero scope, including 267cases of transureteroscope holmium laser, 83 cases of ureteroscnpy, 10 cases of endoscopic inci sion for ureteral stricture,9 cases of placing double J ureteral stents and 3 case of extraction of double J ureteral stents. Result： Eighleen（4.8% ）cases of ureteric injury were happened including 2（ 11. 1 % ）cases of ureteric orifice evulsion,9（50%） cases of ureterodialysis, 4 （22.2%） cases of false passage formation, 2 （ 11.1%） case of ureteric tear and 1 （5.5%）case of avulsed ureter injury. Twenty five patients received expectant treatment with indwelling double J tube,and 5 patients had undergone open operation. During 3 to 12 months follow up,2 cases only exhibi ted mild hydronephrosis, while the others recovered perfectly. Conclusion： We concluded that three key factors could help to avoiding iatrogenic injury= following the surgical indication strictly,improving tbe operation skill and conversion to open operation necessarily.

关 键 词：输尿管镜 医原件损伤 回顾性分析 

分 类 号：R693[医药卫生—泌尿科学]