输尿管镜手术中医源性损伤的诊治体会  

Experience of diagnosis and treatment of iatrogenic injury by ureteroscopic surgery

作　　者：陈达[1] 白焱[1] 夏溟[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院泌尿外科,100038

出　　处：《中华泌尿外科杂志》2013年第12期921-923,共3页Chinese Journal of Urology

摘　　要：目的总结输尿管镜手术中医源性损伤的诊治体会。方法回顾性分析2008年12月至2011年12月收治的13例行输尿管镜手术发生医源性损伤患者的临床资料，男8例，女5例。年龄15～75岁。结石位于左侧输尿管8例，右侧5例。结石病史均〈6个月。本组13例均因输尿管结石行输尿管镜下钬激光碎石术导致医源性损伤。其中发生输尿管口严重撕裂5例，黏膜下损伤4例，输尿管穿孔2例，输尿管撕裂1例，输尿管黏膜袖状剥离1例。结果本组13例中采用双J管内引流治疗10例，引流时间均约60d；中转开放手术3例。随访6个月～2年，复查IVU示患肾均无积水。结论行输尿管镜操作时应熟悉输尿管的解剖及走向，可避免医源性损伤。术后留置双J管有利于轻度输尿管损伤的修复。严重输尿管损伤应及时转开放手术治疗。Objective To summarize the experience of diagnosis and treatment of iatrogenic injury by ureteroseopic surgery. Methods Retrospective analysis of 13 cases with iatrogenie injury by ureterosco- py from December 2008 to December 2011 , including 8 men and 3 women, aged 15 to 75 years. Among the 13 cases （ Holmium laser lithotripsy under ureteroscope） , there were 5 cases of ureterostoma severe disrup- tion, 4 cases of submucosa injury, 2 cases of perforation, 1 case of disruption, and 1 case of sleeve exfoliat- ion of mucosa. Results Among these 13 cases with iatrogenic injury by ureteroscopy, 10 cases underwent double J drainage （drainage duration： 60 days） , and 3 cases underwent open surgery immediately. There was no hydronephrosis when examined by IVU after six months to two years follow-up. Conclusions The skills and techniques of surgical operation should be improved when performing ureteroseopic operation, and it is essential to be familiar with ureteric dissection and alignment, which can avoid ureterie injury. Indwell- ing D-J tube is very important in dealing with mild ureteral injury secondary to ureteroscopes. Surgical inter- vention should be given to severe cases of ureteric injury in time.

关 键 词：输尿管镜 输尿管损伤 输尿管结石 

分 类 号：R699.4[医药卫生—泌尿科学]