输尿管膀胱连接部狭窄合并结石的处理  

Treatment of ureterovesical junction stricture with stones

作　　者：陈耀武[1] 周青[1] 孟军[1] 曾志[1] 杨波[1] 王原[1] 舒畅[1] 朱云海[1] CHEN Yao-wu;ZHOU Qing;MENG Jun;ZENG Zhi;YANG Bo;WANG Yuan;SHU Chang;ZHU Yun-hai(Department of Urology,Baoshan Branch of Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200940,Chin)

机构地区：[1]上海交通大学附属第一人民医院宝山分院泌尿外科,上海200940

出　　处：《第二军医大学学报》2018年第6期691-694,共4页Academic Journal of Second Military Medical University

摘　　要：目的探讨输尿管膀胱连接部狭窄合并结石的个体化处理策略。方法回顾性分析2010年1月至2018年1月我科收治的75例输尿管膀胱连接部狭窄合并结石患者的临床资料。腔内手术处理并留置F5双J管患者50例,其中7例行膀胱镜下输尿管扩张(2例同时切开输尿管开口3~5 mm),41例行输尿管扩张加输尿管镜下气压弹道或钬激光碎石术,2例合并输尿管末端囊肿患者行囊肿切开加输尿管镜下气压弹道碎石术。保守治疗25例,均于肾绞痛控制后予以解痉、利尿、排石治疗。结果行膀胱镜下输尿管扩张的7例输尿管开口处小结石患者,术后1个月复查未见结石,无明显输尿管反流;行输尿管扩张并输尿管镜下碎石术的41例患者,术后1个月复查未见结石;合并输尿管末端囊肿的2例患者,术后1个月复查未见结石,无明显输尿管反流;保守治疗的25例患者术后1~2个月内复查未发现结石。结论输尿管膀胱连接部狭窄应视为一种疾病,需根据结石大小和梗阻情况选择腔内手术或保守治疗,对合并输尿管开口囊肿的病例应切开囊肿。Objective To explore the individualized treatment strategies for ureterovesical junction（UVJ） stricture with stones. Methods The clinical data of 75 patients with UVJ stricture accompanied by stones in our department from Jan. 2010 to Jan. 2018 were retrospectively analyzed. Fifty cases were treated with internal urethrotomy and placed F5 double J tube, including 7 cases with dilation of UVJ through cystoscopy（2 cases were cut open 3-5 mm at UVJ）, 41 cases with dilation plus lithotripsy through ureteroscopy（or holmium laser）, and 2 cases accompanied by cysts at UVJ undergoing lithotripsy after transurethral ureterocele cystotomy. Twenty-five patients received conservative treatment, such as spasmolysis, diuresis and lithagogue after controlling renal colic. Results No stone or ureteral reflux was found in 7 cases with small stones treated with dilation of UVJ or the 2 cases accompanied by cysts at UVJ after one month of follow-up. No stone was found in 41 cases treated by dilation plus lithotripsy under ureteroscope after one month of follow-up. No stone was found in 25 cases with conservative treatment after 1-2 months of follow-up. Conclusion The stricture of UVJ should be regarded as a kind of disease and should be treated with internal urethrotomy or conservative methods according to the stone size and obstruction. For the patients with cyst at the UVJ, cutting cyst is appropriate.

关 键 词：输尿管梗阻 输尿管结石 输尿管镜检查 碎石术 

分 类 号：R693.4[医药卫生—泌尿科学]