输尿管镜钬激光碎石术中输尿管狭窄的处理

Treatment of ureterostenosis during ureteroscopic lithotripsy with Ho:YAG laser

目的探讨输尿管镜钬激光碎石术中输尿管狭窄的处理方法。方法 2008年4月至2009年12月,共行输尿管镜碎石术306例,其中75例合并输尿管狭窄,分别接受输尿管镜下狭窄扩张、钬激光内切开等治疗,回顾性总结处理方法、疗效及其并发症。结果 75例结石合并输尿管狭窄,9例直接开放手术,66例采用输尿管镜下扩张或内切开治疗,其中51例经腔内处理后成功碎石,2例出现术中并发症。出院前复查结石完全清除率84%(63/75),拔除双J管前结石清除率92%(69/75),拔管后1个月结石清除率97.2%(70/72),复查超声无肾积水加重者。结论输尿管结石合并其远端输尿管狭窄可通过输尿管镜腔内技术有效解决。

Objective To improve the treatment of ureterostenosis during ureteroscopic lithotripsy with Ho：YAG laser. Methods From April 2008 to December 2009, 306 cases underwent ureteroscopic lithotripsy, 75 patients of which accompanied ureterostenosis. They respectively received therapy such as dilation or incision under ureteroscopes. Treatment methods, effect and complications were summarized retrospectively. Results 66 cases of 75 patients were treated by dilation or incision under ureteroscopes, 51 cases of which received lithotripsy successfully, and complications occurred in 2 cases. Calculi clearance was 84% by recheck prior to discharge. Before removal of double-J, the clearance was 92%, and one month after removal of double-J, it rised to 97.2%. There was no case with aggravated hydronephrosis through ultrasonic diagnosis. Conclusions Ureteral calculi combined with ureterostenosis could be effectively resolved by endourologic techniques under ureteroscopes. To prehension the main points of operation may elevate the treatment effectiveness and reduce the complications.