输尿管镜检联合钬激光在治疗医源性下段输尿管损伤中的应用(附9例报告)  

The efficacy of ureteroscopy and holmium laser in the treatment of iatrogenic lower ureteral injuries(Report of 9 cases)

作　　者：郝宗耀[1] 刘明[1] 叶元平[1] 邢江湜[1] 张贤生[1] 施浩强[1] 周骏[1] 樊松[1] 王克孝[1] 梁朝朝[1] 

机构地区：[1]安徽医科大学第一附属医院泌尿外科,合肥230022

出　　处：《临床泌尿外科杂志》2012年第12期931-933,共3页Journal of Clinical Urology

摘　　要：目的:探讨经尿道输尿管镜检联合钬激光在治疗医源性下段输尿管损伤中的临床疗效。方法:回顾性分析2009年10月～2012年5月期间采用经尿道输尿管镜检联合钬激光治疗9例医源性下段输尿管损伤患者临床资料:女8例,男1例,平均年龄48.6岁;左侧7例,右侧2例;子宫全切除致损伤5例,直肠癌根治术致伤3例,子宫复发性肿瘤根治术所致1例。经尿道输尿管导管(F3/F5)或斑马导丝引导下缓慢镜检,仔细辨认瘘口进入输尿管近端;若输尿管缝扎闭锁,予以钬激光击碎黏膜下缝线并取出,留置F7或F8双J管。2～3个月后拔除,定期随访。结果:1例患者经尿道输尿管镜下顺利置入双J管引流后治愈;6例患者经尿道输尿管镜下联合钬激光治疗后置入双J管引流,漏尿分别于术后1～7天停止;2例输尿管完全离断患者输尿管镜下置管失败改行输尿管膀胱再植术治愈。手术成功患者留置双J管于术后2～3个月拔除。术后随访6～12个月,静脉肾盂造影(IVU)检查证实患侧尿路连续性恢复,输尿管通畅,肾输尿管积水明显减轻或正常。结论:经尿道输尿管镜检联合钬激光治疗并置入双J管内引流是治疗医源性输尿管损伤(尤其是输尿管误扎后)的有效方法,具有疗效可靠、创伤小、患者易于接受等优点。与传统的行修补或输尿管膀胱再植术相比,术前行输尿管镜检没有增加患者痛苦及并发症,即使微创治疗失败,也为开放手术明确病变位置提供了帮助。Objective：To investigate the clinical efficacy of ureteroscopy and holmium laser in the treatment of iatrogenic lower ureteral injuries. Method： A retrospective analysis was performed of 9 patients （8 women and one man, mean age 48. 6 years） who had received ureteroscopy and holmium laser treatment from 2009 to 2012 for postoperatively detected iatrogenic lower ureteral injuries sustained during gynecologic or general surgery, inclu- ding seven left side ureteral lesions, two right side ureteral lesions. Five cases of iatrogenie ureteral injury occurred in radical hysterectomy, three cases occurred in resection of rectal cancer, and one occurred in the radical resection of uterine recurrent tumor~ mainly postoperative symptoms were abdominal and back pain, fever, urinary leakage, increasing urine leakage of drainage tube. Ureteroscopy were performed with the ureteral catheter （F3/F~ ） or ze hra guide wire, carefully to identify the fistula into the proximal ureter by the guiding, submucosal suture were crushed and removed by the holmium laser when ureteral ligation atresia, indwelling the F7 or F8 double J tube for 2 to 3 months, regular follow-up. Result：All cases were lower ureteral lesions, 1 case was found because of anuria after the operation, seven cases were found leakage of urine a week later, and one case was found after 3 months. One patient was successfully placed double J tube directly, six cases were placed in a double-J tube after ureteros- copy and holmium laser treatment, the leakage of urine were cured after one to seven days, 2 cases were carried ureterocystostomy after failure of ureteroscopy. Double J stent were indwelled in all the cases for 2 to 3 months af- ter extraction, and were followed up for 6 to 12 months. The continuity of the affected side restored urinary tract, ureteral patency, and renal hydroureter significantly reduced or normal, which were confirmed by intravenous urography. Conclusion：The ureteroscopy and holmium laser treatment was an effective technology to

关 键 词：输尿管损伤 医源性疾病 输尿管镜 钬激光 

分 类 号：R693[医药卫生—泌尿科学]