输尿管镜术输尿管口假道发生的机制与处理

Formation, classification and management of intromural false passage of ureter orifice during ureteroscopic procedures

目的回顾性分析输尿管镜术输尿管口假道发生的解剖机制、类型与处理方法。方法从1998年5月至2005年5月,行输尿管镜术990例,其中男585例,女405例,平均年龄43.2岁。左侧543例,右侧447例。结果共发生输尿管口假道62例(6.3%)。以假道和输尿管口的关系分类,输尿管口内侧型60例,外侧型1例,口上型1例,无口下型假道。49例假道在手术医师行输尿管镜术50例以内时(学习曲线期)出现。12例假道由熟练医师操作时出现。除1例输尿管口寻找失败中转开放手术外,其余61例均由熟练医师协助找到输尿管开口完成输尿管镜术。结论常见的输尿管口假道为内侧型,假道多发生于腔内泌尿外科医师的学习曲线期,通常可由熟练医师重新找到输尿管口。熟悉输尿管口假道形成的解剖机制及分类,有利于避免假道的发生及假道发生后输尿管口的寻找。

Objective To study the formation, classification and management of intromural false passage of ureter orifice during ureteroscopic procedures. Methods Fore May 1998 to May 2005, 990 patients （585 males and 405 females; mean age, 43.2 years） were performed ureterosopic procedures in our department in the left ureter of 543 cases and in the right ureter of 447 cases, Results Intromural false passage of ureter orifice were occurred in 62 cases. Of those 60 cases were medial type, one lateral type, one superior type and none inferior type. False passage were happened in 49 cases during doctor＇s learning curve period, and 13 cases in experienced doctors＂ operations. One patient was transfered to open operation because orifice could not be found. All other orifices were found by an experienced doctor. Conclusions The commonest type of intromural false passage of ureter orifice were medial type. Intramural false passage occurred mainly in the period of learning curve of urologist. After intramural false passages occurred, most orifices could be verified by experienced urologist and the procedures stiU might succeed.