斜仰卧截石位双镜联合输尿管会师术治疗医源性输尿管阴道瘘(附42例报告)  

Application of Urethral Realignment for Iatrogenic Ureterovaginal Fistula by Combined Endoscopic Approaches

作　　者：韩增箎[1] 刘丽[2] 赵谦[1] 席兰[1] 宋飞[1] 侯飓[1] 郭环宇[1] 黄伟[1] 邵建国[1] 

机构地区：[1]山东中医药大学第二附属医院泌尿外科,济南250001 [2]山东省章丘市人民医院外科,章丘250012

出　　处：《中国微创外科杂志》2013年第11期1015-1017,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨内镜手术治疗医源性损伤导致输尿管阴道瘘的方法及临床效果.方法 2005年2月～ 2013年1月,选取42例医源性输尿管损伤后输尿管阴道瘘,采用经皮肾穿刺造瘘Wolf F9.8输尿管短镜联合经尿道输尿管长镜引导置入双J管行输尿管会师术.结果 2例失败,肾造瘘术后3个月行开放手术.40例手术成功者漏尿于术后逐渐减少并在48小时内停止.术后1个月输尿管窦道基本成形,术后2个月拔除肾造瘘管,3个月复查静脉肾盂造影（IVP）,患侧输尿管通畅,拔双J管.随访6～24个月,平均14.7月,无并发症发生.结论 经皮肾穿刺造瘘联合经尿道输尿管镜下输尿管会师术是处理输尿管阴道瘘的有效治疗方法.Objective To study the procedure of endoscopic surgery for iatrogenic ureterovaginal fistula and its clinical effect.Methods From February 2005 to January 2013,percutaneous nephrostomy with Wolf F9.8 short ureterscope plus the placement of a double J catheter under the guidance of the Wolf Fg.8 long ureterscope through urethra was conducted to undergo urethral realignment in the treatment of 42 cases of ureterovaginal fistula caused by iatrogenic ureteral injury.Results Two surgeries failed and underwent open surgery three months after percutaneous nephrostomy.The leakages of urine in 40 patients stopped in 48 hours after surgery,the ureteral sinus was basically taken shape one month after surgery,the nephrostomy tube was removed two months later and the ipsilateral ureter was unobstructed as was shown by intravenous pyelography 3 months after the surgery.Then the double J catheter was removed.In a postoperative follow-up of 6 to 24 months （average,14.7 months）,no complications were found.Conclusion Percutaneous nephrostomy plus endoscopic urethral realignment is an effective treatment for iatrogenic ureterovaginal fistula.

关 键 词：输尿管镜 经皮肾穿刺造瘘 输尿管损伤 输尿管阴道瘘 

分 类 号：R699[医药卫生—泌尿科学] R713[医药卫生—外科学]