输尿管镜术中困难和并发症的原因与对策

The Dfficulties and Cmplications of Ueteroscopy and the Mangement Strategies

目的:探讨输尿管镜术中困难和并发症的原因及应对策略。方法:回顾性分析1998年3月～2008年10月行输尿管镜手术的900例患者临床资料。结果:900例患者中,术中困难83例,其中45例为早期病例;中转开放手术24例,其中14例为早期病例。24例中转开放手术的原因为:未找到输尿管3例(12.5%),入镜失败5例(20.9%),上镜困难(未达到病变部位)5例(20.9%),输尿管穿破7例(29.1%),输尿管断裂2例(8.3%),结石上移2例(8.3%)。结论:输尿管镜术中困难和并发症与操作者的经验密切相关,掌握手术适应证,术前加强培训,熟练操作技巧,是减少手术失败率和并发症的关键。

Objective：To analysis the difficulties and complications emerged during transurethral ureteroscopy and offer their management strategies. Methods： A total of 900 patients accepting rigid transurethral ureteroscopy from May 1998 to October 2008, were evaluated retropspeetively. Results： Among 900 cases, 83 cases were found difficulties during transurethral ureteroscopy, of which 45 cases were early cases. 2.6% cases （24 cases） were converted to open surgery, of which 14 cases were early cases. The causes of conversion to open include： ureteral orifice of 3 patients could not be found（12.5%）, ureteroscopy failed to enter ureteral orific in 5 patients （20.9%）, ureteroscopy failed to get to the ill place in 5 patients （20.9%）, ureter perforation occurred in 7 patients （29. 1%） , ureter avulsion occurred in 2 patients （8.3%）, stones shifted to renal pelvis in 2 patients （8.3%）. Conclusions： There are more difficulties and complications during ureteroscopy at early stage. Strictly mastering surgical indications, strengthening preoperative training, mastering the surgical technique is the key to reduce the failure rate and comphcations of ureteroscopy.