输尿管镜术中输尿管镜嵌顿致退镜困难45例处理体会  

Analysis of the ureteroscope retreating difficulties after ureter incarceration during rigid transurethral ureteroscopy

作　　者：杜东岭[1] 杨春亭[1] 李志斌[1] 赵国防[1] 万小华[1] 严跃龙[1] 姜华龙[1] 

机构地区：[1]中山大学附属东莞东华医院泌尿外科,广东东莞523110

出　　处：《中国内镜杂志》2013年第4期397-401,共5页China Journal of Endoscopy

摘　　要：目的总结1218例输尿管镜手术患者中45例术中输尿管镜嵌顿致退镜困难者的临床资料,探讨输尿管镜手术时输尿管镜嵌顿致退镜困难的原因与对策。方法 15例是采用与麻醉师充分沟通,适当增强肌松剂,注入少量水性润滑剂和1%利多卡因后拔出镜体;13例术中经上述方法处理无效改全身麻醉后拔出镜体;5例未经特殊处理,耐心等待10～30min输尿管松弛后拔出镜体;10例术中经尿道置入另1根输尿管镜,在异物钳帮助下轻轻旋转摆动拔出镜体;2例输尿管上段结石患者行气压弹道碎石治疗时发现输尿管镜嵌顿于输尿管内强行退镜致输尿管黏膜撕脱,其中1例术中立即行肠代输尿管术,1例行开放手术输尿管膀胱再植术。结果 43例发生输尿管镜嵌顿致退镜困难患者采用适当的处理措施,都能顺利退镜并避免严重并发症的发生,也不需开放手术取出镜体。2例因强行退镜致输尿管黏膜撕脱,1例术中立即行肠代输尿管术,1例行开放手术输尿管膀胱再植术。2例均恢复良好。结论输尿管镜术中发生输尿管镜嵌顿采取适当的处理措施可避免强行退镜导致输尿管黏膜撕脱等严重并发症的发生。[Objective] To analyze the causes of ureteroscope retreating difficulties during rigidity ransurethral ureteroscopy and their management.45 cases of ureteroscope retreat difficulty happened during rigid transurethral ureteroscopy were evaluated retrospectively.[Methods] Of the 45 cases ureteroscopy,15 cases achieved ureteroscope retreating through sufficient communication with anesthetist,added appropriate Skelaxin and infused small amount of lubricato and lidocaine.13 cases achieved successful ureteroscope retreating with the help of general anesthesia.10 cases achieved successful ureteroscope retreating with the help of pincers through another transurethral ureteroscopy the first ureteroscopy was incarcerated by the end piece of ureteroscope.5 cases achieved successful ureteroscope just waiting for 10～30 minutes patiently.Avulsion of mucous membrane of ureter happened on 2 cases when retreat ureteroscope by force,one received intestinal generation ureteral operation immediately and the other received ureteral reimplantation.[Results] 43 of the 45 cases achieved successful ureteroscope retreating by taking some proportionate skills during rigid transurethral ureteroscope.Avulsion of mucous membrane of ureter happened on 2 cases when retreat ureteroscope by force,one received intestinal generation ureteral operation immediately and the other received ureteral reimplantation.Both of them had good recovery.[Conclusions] Some proportionate skills were taken when ureter incarceration happened during rigid transurethral ureteroscope can avoid severe complications such as avulsion of mucous membrane of ureter when retreat ureteroscope by force.

关 键 词：输尿管镜 输尿管镜嵌顿 并发症 

分 类 号：R693.5[医药卫生—泌尿科学]