输尿管镜钬激光内切开术治疗UPJ狭窄

Retrograde ureteroscopic endotomy using holmium∶YAG laser on treatment of Ureteropelvic junction obstruction

目的:探讨经尿道输尿管镜钬激光内切开术治疗肾盂输尿管连接部狭窄的效果。方法:2004年10月～2007年6月期间,经尿道输尿管镜下钬激光内切开治疗成人型肾盂输尿管连接部狭窄23例。狭窄段纵行切开后,输尿管内放置F7双J管内引流,平均留置双J管10周,每3个月行超声、排泄性尿路造影检查。结果:术后随访6～24个月,平均16个月,19例临床症状缓解,影像学检查提示内切开段造影剂通过良好,治疗成功;4例手术失败,改行Aderson-Hynes离断性肾盂成形术治愈。结论:经尿道输尿管镜下钬激光肾盂内切开术创伤小、安全有效,可做为轻中度肾盂积水肾盂输尿管连接部狭窄患者治疗的首选方法。

Objective.. To evaluate the therapeutic effect of retrograde ureteroscopic Ho..YAG laser endopyelotomy for correction of ureteropelvic junction（UPJ）obstruction. Methods：From 2004. 10- 2007.6, retrograde ureteroscopic Ho：YAG laser endopyelotomy was carried out on 23 adult patients of UPJ obstruction. The obstruction was incised with a holmium laser fiber in a linear fasion. After completing incision, a french-7 double-J ureteral stent was left for 10 weeks. Thereafter, patients were monitored with excretory urography, B-ultrasound at 3 months regular intervals. Success was defined as symptomatic relief and radiographic resolution. Results： Success was achieved in 19 cases without complication in-or post-operation at average follow up for 16 months （6- 24 months）. However,4 cases of were ineffective. Conclusions： This procedure should be used initially for the treatment of some patients suffering from UPJ obstruction, because it is less invasive and effective.