输尿管镜碎石术后输尿管狭窄的原因分析和处理策略  

Cause analysis and management of ureteroscopic lithotripsy related ureteral stenosis

作　　者：盛明[1,2] 陈佳汇 刘兴 卞军[1,2] 赖德辉 Sheng Ming;Chen Jiahui;Liu Xing;Bian Jun;Lai Dehui(Department of Urology,The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510799,China;Guangzhou Key Laboratory of Enhanced Recovery After Surgery in Abdominal Surgery,Guangzhou 510799,China)

机构地区：[1]广州医科大学附属第五医院泌尿外科,广州510799 [2]广州市加速康复腹部外科重点实验室,广州510799

出　　处：《国际医药卫生导报》2023年第3期409-413,共5页International Medicine and Health Guidance News

基　　金：广州市医学重点学科项目(2021~2023);广州医科大学校级临床重点专科项目(广医大发〔2020〕5号);广东省研究生学术论坛-泌尿外科再生医学与转化医学分论坛(2022XSLT038)。

摘　　要：目的分析和探讨输尿管镜碎石术后发生输尿管狭窄的原因和处理策略。方法回顾性分析2016年12月至2018年12月广州医科大学附属第五医院收治的60例输尿管镜碎石术后经输尿管镜镜检诊断为输尿管狭窄患者的临床资料,其中男28例,女32例,年龄(48.1±10.5)岁。所有患者均采用了输尿管镜钬激光碎石术进行手术治疗。除输尿管结石疾病外,患者均无其他严重的基础疾病。对患者的年龄、性别、体质量指数、术前合并症,输尿管狭窄长度、处理方法和处理次数做相应记录和分析。结果60例患者随访时间为(2.6±1.1)年,输尿管狭窄长度为(1.7±1.2)cm,手术处理输尿管狭窄的次数为(4.1±1.5)次。所有患者均为输尿管镜钬激光碎石术后发生输尿管狭窄。仅有24例(40.0%)患者行输尿管狭窄内切开结合球囊扩张后成功处理,6例(10.0%)患者长期留置输尿管内支架,3例(5.0%)患者长期留置肾造瘘管,21例(35.0%)患者需要行尿路重建手术,6例(10.0%)患者行患肾切除术。结论输尿管镜钬激光碎石术引起输尿管狭窄的腔内治疗成功率低,不推荐使用钬激光原位碎石,轻柔的手术操作和恰当的碎石方式有利于减少术后输尿管狭窄的发生。Objective To analyze and discuss the causes and management of ureter stenosis after ureteroscopic lithotripsy.Methods The clinical data of 60 patients with ureteral stenosis diagnosed by ureteroscopy after ureteroscopic lithotripsy admitted to The Fifth Affiliated Hospital of Guangzhou Medical University from December 2016 to December 2018 were retrospectively analyzed,including 28 males and 32 females,aged(48.1±10.5)years.All the patients were treated with ureteroscopic holmium YAG laser lithotripsy.All the patients did not have serious underlying diseases except for ureterolithiasis.The patients'age,gender,body mass index,and preoperative complications,and length,treatment methods,and treatment times of ureteral stenosis were recorded and analyzed.Results The follow-up period was(2.6±1.1)years.The length of ureteral stenosis was(1.7±1.2)cm.The times of surgical treatment of stenosis were(4.1±1.5)times.All the patients suffered from ureteral stenosis after ureteroscopic holmium YAG laser lithotripsy.Only 24 cases(40.0%)were successfully treated by endourological treatment(endoscopic balloon dilation combined with internal incision),6 cases(10.0%)needed long-term indwelling of ureteral stent,3 cases(5.0%)needed long-term indwelling of nephrostomy tube,21 cases(35.0%)underwent urinary tract reconstruction,and 6 cases(10.0%)underwent nephrectomy for severe renal impairment.Conclusions The successful rate of endoscopic surgery for ureteral stenosis after ureteroscopic holmium YAG laser lithotripsy is low.Therefore,we recommend against use of ureteroscopic holmium YAG laser lithotripsy.Gentle operation and appropriate lithotripsy are beneficial to reduce the incidence of postoperative ureteral stenosis.

关 键 词：输尿管镜 输尿管结石 输尿管狭窄 钬激光 

分 类 号：R699.4[医药卫生—泌尿科学]