输尿管镜下钬激光内切开与离断性肾盂成形术治疗UPJ狭窄的疗效评价  

Comparisrion of ureteroscopic endotomy with Dismembered pyeloplasty for recurrent ure- teropelvic junction obstruction

作　　者：汪前亮[1] 杨嗣星[1] 

机构地区：[1]武汉大学人民医院泌尿外科,湖北430060

出　　处：《国际泌尿系统杂志》2013年第1期6-9,共4页International Journal of Urology and Nephrology

摘　　要：目的探讨经尿道输尿管镜下钬激光内切开术与离断性肾盂成形术治疗UPJ狭窄的疗效评价。方法回顾性分析本院2009年～2012年期间收治的120例肾盂输尿管连接部狭窄患者，均经过彩超，肾分泌造影，MRI水成像或逆行造影等明确诊断，患者分为两组，输尿管镜下钬激光内切开术组（58例）和离断性肾盂成形术组（62例），术后所有患者输尿管内留置Fr7号双J管内引流，每3个月行超声、排泄性尿路造影检查。结果输尿管镜钬激光内切开组手术时间（50．6±15．6）min、术后住院时间（7．5±2．5）d、平均出血量10ml，明显优于开放肾盂成形组（120．6±26．4）rain、术后住院时间（16．5±3．6）d、平均出血量200ml（P〈0．05），两组病人术后每3个月复查泌尿系彩超及静脉肾盂造影，随访6～18个月，平均12个月，术后两组肾积水疗效评价，输尿管钬激光内切开组：40例治愈，16例好转，2例手术失败，改行离断性。肾盂成形术治愈；开放肾盂成形术组：35例治愈，20例好转，7例无效。结论肾盂输尿管连接部狭窄的部分病例选择输尿管镜下钬激光内切开术治疗的手术效果可达到开放手术水平、在手术时间、术中出血量、术后住院时间等方面明显优于开放手术组，输尿管镜下钬激光内切开术是一种安全、有效、术后恢复快、创伤小的治疗方法。Objectives To comparisrion the therapeutic effect of ureteroscopic endotomy using Ho： YAG laser with Dismembered pyeloplasty for recurrent ureteropelvic junction obstruction. Methods From 2009 to 2011,120 patients with recurrent ureteropelvic junction obstruction , of these patients, 58 cases underwent uretero- scopic endotomy and 62 cases underwent dismembered pyeloplasty, a 7F D - J catheter was inserted, the operative time, average intraoperative blood loss and postoperative length of hospital stay of the two groups were analyzed. Re- sults The ureteroscopic endotomy group had fewer operative time（50.6 ~ 15.6min vs 120.6 ＋ 26.4min, P 〈 0. 05 ）, shorter postoperative length of hospital stay （7.5 ~ 2.5 d vs 16.5 ~ 3.6d, P 〈 0.05 ）, the mean intraoperative blood loss was 10ml vs 200ml in the open group（ P 〈 0.05 ）, 69% cure rate and 28% improvement rate in the uret- eroscopic endotomy group and 56% cure rate and 30% improvement in the open group at a follow up of 6 ~ 18 months. Conclusions

关 键 词：输尿管梗阻 肾盂 激光 钬 输尿管镜检 

分 类 号：R699[医药卫生—泌尿科学]