上尿路手术术后双J管滞留的原因与腔镜处理

Analysis of Failed Removal of Double J Ureteral Stents Following the Operation of Upper Urinary Tract and Its Endoscopic Treatment

目的:分析上尿路手术术后双J管滞留的原因,评价局麻下输尿管镜拔出滞留双J管的临床应用价值。方法:回顾分析21例上尿路手术术后双J管滞留患者的原因与采用尿道黏膜麻醉下经尿道输尿管镜拨出双J管的临床疗效。结果:21例患者中,3例双J管内外结石形成,6例双J管上端缝合,9例双J管向上移位致输尿管致拔管困难,2例输尿管下段狭窄环存在,1例输尿管下段阴性结石致双J管未能置入膀胱;2例输尿管下段狭窄患者,拔出双J管后重新置入双J管,1例输尿管下段阴性结石患者行腔内气压弹道碎石术后更换双J管,余18例均用输尿管镜顺利拔出双J管,无输尿管穿孔、假道及泌尿系感染等并发症;输尿管镜操作平均时间3.6 min;无因疼痛难以忍受而终止手术者。结论:熟练正确的双J管置入法与术前上尿路情况的充分了解是避免上尿路手术术后双J管滞留的关键,局麻下应用输尿管镜技术拔出滞留双J管是可行的。

Objective. To analyze the causes of failed removal of double J ureteral stents following the operation of upper urinary tract and evaluate the application value of uretroscopy to remove them under urethral mucosae anesthesia. Methods： From Sept. 1998 to May 2006, a total of 21 cases of failed removal of double J ureteral stents following the operation of upper urinary tract were treated by the way of uretroscopy under urethral mucosae anesthesia. Results. For the causes of failed removal of double J ureteral stents, 3 of the 21 cases related to the genesis of encrusted stone, meanwhile, 6 cases were sutured on the upper end of double J ureteral stent, and 9 due to the remove upward the ureter. Another 3 cases could not be placed in bladder for the obstruction of lower ureter. One case o stent after removing dou f negative stone in lower ureter was replaced with a new double J ureteral ble J ureteral stent following treatment with transurethral ureteroscopy ballast lithotrity. Two cases with the stricture of lower ureter also were replaced with a new double J ureteral stent after removing. The double J ureteral stents were removed in the other 18 cases successfully. The mean operative time was 3.6 rain, without serious complications and cessation of operation because of pain. Conclusion： The keys to avoid the failed removal of double J ureteral stent are the correct operation plan and accurate method to place it and familiarity of the anatomy of urinary tract thoroughly. It＇s an efficient, safe and convenient treatment to remove them using ureteroscope under urethral mucosae anesthesia.