输尿管镜腔内治疗输尿管狭窄(附65例报告)  

Endourologic management of ureteral stricture by ureteroscopy (Report of 65 cases)

作　　者：辛晓雷 方林[1] XIN Xiaolei;FANG Lin(Department of Urology,Zhongshan Hospital Affiliated to Xiamen University,Xiamen,Fujian,361004,China)

机构地区：[1]厦门大学附属中山医院泌尿外科,福建厦门361004

出　　处：《临床泌尿外科杂志》2023年第3期218-222,共5页Journal of Clinical Urology

摘　　要：目的:总结输尿管镜腔内治疗输尿管狭窄的临床疗效。方法:回顾性分析65例应用输尿管镜腔内技术治疗输尿管狭窄患者的临床资料。男34例,女31例;年龄18~73岁,平均42岁。其中狭窄段长度<0.5 cm者13例,0.5~1.5 cm者40例,1.6~2.0 cm者12例。狭窄段位于肾盂输尿管连接部(UPJ)者6例,输尿管上段者23例,中段者14例,下段者22例。1例经腔内球囊扩张联合Allium覆膜金属输尿管网状支架植入术,3例经尿道输尿管镜球囊扩张联合腔内钬激光内切开术,13例行钬激光内切开术,14例行导管扩张术,16例行输尿管镜镜体扩张术,18例行球囊扩张术。结果:65例患者中,63例成功行腔内治疗,2例因腔内治疗失败,更改手术方式,1例行输尿管狭窄段切除+端端吻合术,1例行腹腔镜下输尿管狭窄段切除+端端吻合术。术后1年获随访57例,43例(75.4%)一次手术治愈;14例(24.6%)狭窄复发,其中1例行膀胱肌瓣输尿管成形术,2例行腹腔镜下输尿管狭窄段切除端-端吻合术,2例行输尿管膀胱再植术,9例行再次腔内治疗。结论:输尿管镜腔内治疗输尿管狭窄并发症少、恢复快,是一种安全、有效的微创治疗技术。Objective: To investigate the efficacy of ureteroscopy for the treatment of ureteral stricture. Methods: The clinical data of 65 patients with ureteral stricture treated by ureteroscopy were analyzed retrospectively. There were 34 males and 31 females. The age ranged from 18 to 73 years, with an average of 42 years. The stenosis length was less than 0.5 cm in 13 cases, 0.5 cm to 1.5 cm in 40 cases, and 1.6 cm to 2.0 cm in 12 cases. The stricture was located at the ureteropelvic junction(UPJ) in 6 cases, at the upper ureter in 23 cases, at the middle ureter in 14 cases, and at the lower ureter in 22 cases. Transurethral ureteroscopic balloon dilatation combined with implantation of Allium covered metal ureteral mesh stent was performed in 1 case, transurethral ureteroscopic balloon dilatation combined with endoluminal holmium laser incision in 3 cases, endoluminal holmium laser incision in 13 cases, catheter dilatation in 14 cases, ureteroscopic dilatation in 16 cases and balloon dilatation in 18 cases. Results: Among the 65 cases, 63 cases were successfully treated by endoureterotomy, 2 cases were not. One case was treated by ureterostenosis resection and end-to-end anastomosis, and the other was treated by laparoscopic ureterostenosis resection and end-to-end anastomosis. Fifty-seven cases were followed up for 1 year after operation. Forty-three cases(75.4%) were cured by one operation, while other 14 cases(24.6%) had stenosis recurrence. Among the recurrence patients, 1 case underwent bladder muscle flap ureteroplasty, and 2 cases underwent laparoscopic resection of ureteral stenosis and end-to-end anastomosis, 2 cases of ureterobladder reimplantation, 9 cases of endourologic surgery again. Conclusion: Endourologic management of ureteral stricture is a safe, effective and minimally invasive method with lower complication rate and fast recovery.

关 键 词：输尿管镜技术 输尿管狭窄 扩张 内切开 

分 类 号：R693.2[医药卫生—泌尿科学]