输尿管镜手术上镜困难的原因与对策

Analysis of the access diffculties during rigid transurethral ureteroscopy and management

目的:探讨输尿管镜手术时上镜困难的原因与对策。方法:报告在收治的182例输尿管镜手术患者中24例上镜困难者的临床资料。结果:10例是采用技巧性的旋转及变换角度才获入镜;14例有不同程度的狭窄或迂曲,经扩张或调整体位后有12例成功,1例中转开放,1例插管后行ESWL。结论:克服输尿管上镜困难的重要措施是熟悉输尿管解剖与熟练技巧性操作,术中防止输尿管穿孔及粘膜撕脱尤其重要。

Objective：To analysis the causes of diffcult access during rigid transurethral ureteroscopy and their management. Methods：From March 2005 to Junuary 2006,182 cases of rigid transurethral ureteroscopy were evaluated retrospectively. Results：Of the 182 cases ureteroscopy, diffcult accesses were encountred in 24 cases, but 10 of 24 cases succeed to achieve with skill, 12 of 14 cases with ureter stricture or flexura were rendered to dilate satisfactlly,but for the other two, one was tranfered to operation, and one ESWL with ureter catheter. Conclusions： Diffcult access to ureter is not rare, we should be familiar with the anatomy of ureter and master the techniques of operation.