球囊扩张技术在儿童输尿管镜钬激光碎石术进镜困难时的应用  

Application of Balloon Dilation Technique When Difficult Ureteroscope Accessing in Ureteroscopic Holmium Laser Lithotripsy in Children

作　　者：高靖达 周云[1] 高瑞峰[1] 许鹏 齐灿[1] 高栩 柴红超[1] 贾鹏宇 Gao Jingda;Zhou Yun;Gao Ruifeng(Department of Urology,Hebei Children’s Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院泌尿外科,石家庄050000

出　　处：《中国微创外科杂志》2024年第10期662-665,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：河北省医学科学研究课题计划(20220715)。

摘　　要：目的探讨儿童输尿管镜钬激光碎石术进镜困难时应用球囊扩张技术的有效性及安全性。方法回顾性分析2020年3月~2023年10月23例(25侧)输尿管镜钬激光碎石术中应用球囊扩张技术的资料。进镜困难时,经输尿管镜工作通道置入输尿管扩张球囊导管对管腔狭小部位进行扩张,进镜置入钬激光光纤,粉末化结石。结果本组23例(25侧)输尿管结石,行输尿管扩张球囊导管扩张输尿管共26处,扩张部位为输尿管膀胱壁内段23处,输尿管下段3处,扩张后输尿管Ⅰ级损伤23处,Ⅱ级损伤3处。球囊扩张后继续碎石成功23侧,失败2侧。均未出现与输尿管球囊扩张相关并发症。拔除双J管时间26~45 d,(33.5±5.2)d,在此期间尿路感染5例。拔除双J管后2周内复查泌尿系超声,结石均排出,均无肾积水。随访6~24个月,平均13.7月,均无输尿管狭窄表现。结论输尿管镜进镜困难时经工作通道使用输尿管扩张球囊导管进行扩张安全、有效。Objective To investigate the effectiveness and safety of balloon dilation technique when difficult ureteroscope accessing in ureteroscopic holmium laser lithotripsy in children.Methods Clinical data of 23 patients(25 sides)receiving ureteroscopic holmium laser lithotripsy with using balloon dilatation technique from March 2020 to October 2023 were retrospectively analyzed.When it was difficult to insert ureteroscope,the ureteral balloon catheter was retrogradely inserted through the ureteroscopic working channel to dilate the narrow part of the ureteral lumen.After dilation,the holmium laser fiber was inserted to powder the stones.Results Of the 23 patients(25 sides)with ureteral calculi,transcatheter ureteral balloon dilation was carried out in 26 places during the operation,including 23 places located in the inner part of the ureteral bladder wall and 3 places located in the lower part of the ureter.The extent of ureteral injury at dilated sites was gradeⅠin 23 places and gradeⅡin 3 places,respectively.After ureteral balloon dilatation,continued lithotripsy succeeded on 23 sides and failed on 2 sides.No complications related to ureteral dilated balloon catheter were found.The time for removing double-J ureteral stents was 26-45 d(mean,33.5±5.2 d),during which urinary tract infection occurred in 5 cases.Urinary system ultrasound examination was performed within 2 weeks after removal of double-J ureteral stents.The calculi were discharged in all the children,without hydronephrosis.No ureteral stenosis was observed in all the children during 6-24 months(mean,13.7 months)of postoperative follow-ups.Conclusion It is safe and effective to dilate the ureteral with balloon dilation technique through the working channel when difficult ureteroscope accessing.

关 键 词：球囊扩张 输尿管结石 儿童 输尿管镜手术 碎石术 

分 类 号：R726.9[医药卫生—儿科]