钬激光腔内治疗输尿管肾盂连接处狭窄

Retrograde endopyelotomy using Holmium: YAG laser on treatment of ureteropelvic junction obstruction

目的探讨钬激光腔内治疗肾盂输尿管交界处狭窄(UPJO)的方法及疗效。方法对14例UPJO患者采用钬激光腔内治疗,于狭窄段后外侧全层切开输尿管壁直至肾周脂肪,术后留置双J管6～8周。全部患者获得随访,平均随访10.5个月(4～27个月)。结果手术时间30～60min,术后平均住院3d(2～6d)。临床症状改善明显,影像学显示内切开段造影剂通过良好12例,2例治疗失败者再次给予钬激光腔内切开,1例随访8个月显示治疗成功,1例随访4个月,目前临床症状改善。结论钬激光腔内切开治疗UPJO具有微创、住院时间短、疗效可靠、可重复进行等特点,可作为对部分UPJO病人进行微创治疗的首选。

[Objective ] We report our experience of retrograde ureteroscopic endopyelotomy using the holmium laser for ureteropelvic junction obstruction（UPJO） not associated with upper tract stones. [Methods] We carried out this procedure on fourteen patients through a 8.5-Fr rigid ureteroscope. The ureter was not stented before the procedure and balloon dilation was not necessary before retrograde insertion of the ureteroscope. The obstruction was in- cised with the holmium laser using a 200 microm fiber in a linear fashion. After completing the incision, a double-J ureteral stent was left for 6-8 weeks. Thereafter, patients were monitored with renal scan and/or ultrasound and excretory urography at 3-6 month intervals. [Results] Hydronephrosis was obviously improved in twelve cases （85.6%） at an average follow up of 10.5 months （4-27 months）. [Conclusion] Retrograde ureteroscopic endopyelotomy for UPJ obstruction using the holmium laser achieved good results. We recommend that this procedure be used initially for patients with good renal function and mild dilation of the pelvicaliceal system because it is less invasive and has a favorable outcome.