输尿管镜扩张法和钬激光内切开法治疗输尿管狭窄  

Ureteroscopic Dilation or Holmium Laser Endoureterotomy for Ureteral Stricture

作　　者：蒋少华[1] 余良[1] 孙航[1] 周春辉[1] 孙文[1] 吕晓辉[1] 

机构地区：[1]解放军第三医院泌尿外科,宝鸡721004

出　　处：《中国微创外科杂志》2015年第5期428-430,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨输尿管狭窄2种腔内治疗方法的选择和疗效。方法 2010年6月~2013年12月对46例输尿管狭窄根据术中观察狭窄的程度,结合术前静脉尿路造影（introvenous urography,IVU）和CT泌尿系成像（CT urography,CTU）,选择输尿管镜直接扩张法（狭窄程度较轻者）或钬激光内切开法（狭窄程度重、狭窄长度长,或术中输尿管镜扩张困难者）,术后留置输尿管支架管,1~2个月后拔除。结果 46例手术均顺利完成,无输尿管撕脱、严重出血等并发症。42例临床治愈（其中输尿管镜扩张17例,钬激光内切开25例）,B超显示42例肾积水均减轻,肾集合系统分离由术前（3.64±0.83）cm降至术后（1.96±0.58）cm（t=10.111,P=0.013）;IVU和CTU显示狭窄近段输尿管扩张减轻,由术前（16.9±1.5）mm减少为术后（9.5±1.0）mm（t=25.079,P=0.000）,输尿管狭窄段增宽,由术前（2.1±0.3）mm增宽到术后（5.1±0.4）mm（t=-37.371,P=0.000）。结论根据输尿管狭窄不同程度和长度,以及术中操作的实际情况,合理选择镜体直接扩张法或钬激光内切开法治疗输尿管狭窄可取得良好的效果。Objective To investigate the selection and efficacy of endoscopic methods for the treatment of ureteral stricture . Methods Clinical data of 46 patients with ureteral stricture were analyzed retrospectively .Based on the stricture extent displayed under ureteroscope and the stricture radiography of introvenous urography or CT urography , either ureteroscopic dilation （ for mild stricture） or holmium laser endoureterotomy （for severe stricture, long stricture, or difficulty of ureteroscopic dilation ） was carried out. Results All the patients received operation successfully , and no severe complications were observed .Forty-two patients were clinically cured, including 17 patients undergoing ureteroscope dilation and 25 patients undergoing endoureterotomy .Ultrasonic examinations showed relieved hydronephrosis in these 42 patients.The separation of the renal collecting system was reduced from （3.64 ±0.83） cm to （1.96 ±0.58） cm （t=10.111, P=0.013）.IVU and CTU showed the proximal dilated ureter was reduced from （16.9 ±1.5） mm preoperatively to （9.5 ±1.0） mm postoperatively （t=25.079, P=0.000）.The stricture segment was dilated from （2.1 ±0.3） mm to （5.1 ±0.4） mm （t =-37.371, P=0.000）.In the ureteroscopic dilation patients, 17 cases （89.5%） were cured clinically.In the endoureterotomy patients, 25 cases （92.6%） were cured. Conclusion Based on the stricture extent and the stricture length , as well as specific operational conditions , proper selection of dilation or endoureterotomy for ureteral stricture could achieve good outcomes .

关 键 词：输尿管狭窄 输尿管镜 钬激光 内切开 

分 类 号：R699[医药卫生—泌尿科学]