顺行钬激光腔内切开治疗输尿管肾盂连接处狭窄

Percutaneous antegrade endopyelotomy using Holmium laser on the treatment of ureteropelvic junction obstruction

目的探讨经皮肾微造瘘钬激光腔内切开治疗肾盂输尿管交界处狭窄(UPJO)的方法及疗效。方法对13例UPJO患者采用经皮肾微造瘘钬激光腔内治疗,于狭窄段后外侧全层切开输尿管壁直至肾周脂肪,对其中合并肾及肾盂结石的7例患者同时给予钬激光碎石,术后留置双J管6～8周。全部患者获得随访,平均随访10(3～27)个月。结果手术时间60～90min,术后平均住院6(5～7)d。临床症状改善明显、影像学显示内切开段造影剂通过良好9例,4例治疗失败者再次给予经皮肾微造瘘钬激光腔内切开,1例随访13个月显示治疗成功,3例分别随访4、6、9个月,目前临床症状改善。结论经皮肾微造瘘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(尤其合并上尿路结石、感染的患者)进行微创治疗的首选。

[Objective] To explore of percutaneous antegrade endopyelotomy using the holmium laser for ureteropelvic junction obstruction （UPJO） associated with upper tract stones. [Methods] We carried out this procedure on 13 patients through an 8.5-Fr rigid ureteroscope. The ureter was not stented before the procedure and balloon dilation was not necessary before antrograde insertion of the ureteroscope. The obstruction was incised with holmium laser using a 200 microm fiber in a linear fashion. After completion of 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 9 cases at an average follow up of 10 months （3-27 months）. [Conclusion] Percutaneous antegrade endopyelotomy for UPJ obstruction using the holmium laser achieved good results, We recommend that this procedure could 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,especially associated with upper tract stones and infection.