逆行输尿管镜手术并发症（附2316例报告）

Complications of retrograde rigid ureteroscopy（ report of 2316 cases ）

目的总结分析逆行输尿管镜手术并发症的发生原因及防治措施。方法对本院2004年10月-2010年10月2316例病人2468次逆行输尿管镜手术的临床资料进行回顾性分析。结果总的并发症发生率7．1％（165／2316），操作失败78例（3．4％）；结石移位至肾盂26例（1．1％）；输尿管损伤30例（1．3％），其中膀胱壁内段穿孔形成输尿管黏膜下隧道9例（0．4％）、全层穿孔14例（0．6％）、部分断裂4例（0．2％）、黏膜撕脱3例（0．1％）；输尿管内双J管移位10例（0．4％）；16例（0．7％）出现早期术后并发症，包括严重感染5例（0．2％），持续较严重的血尿6例（0．3％），较严重的肾绞痛5例（0．2％）；5例（0．2％）出现远期并发症，包括输尿管狭窄3例、持续存在膀胱输尿管返流2例。大部分的手术并发症（124例，75．2％）发生在操作者使用输尿管镜的最初2年中。结论严格掌握手术适应证，提高术中操作技巧，采用正确的对应措施，能有效地减少并发症。

Objectives To summarize the complications of retrograde rigid ureteroscopy as well as their management. Methods A total of 2316 patients accepting retrograde rigid ureteroscopy from Oct 2006 to Oct 2010 were evaluated retropspectively. Results The rate of complications was 7. 1% （165/2316）. The complications consisted of the ureteroscopy failure （78 cases, 3.4% ）, migration of catcall（26 cases, 1. 1% ）, ureteral injury （mucosal false passage [9 cases, 0.4% ], ureteral perforation [ 14 cases, 0.6% ], ureteral part fracture [4 cases, 0.2% ] , ureteral avulsion [ 3 cases, 0.1% ] ）, migrated double -J stent （10 cases, 0.4% ）. Early complications were described in 0.7% （ 16 cases） ： sepsis （5 cases, 0.2% ）, serious persistent hematuria （6 cases, 0. 3% ）, se- rious renal colic （5 cases, 0.2% ）. Late complications were ureteral stenosis （3 cases, 0. 1% ） and persistent vesi- coureteral reflux （2 cases, 0.1% ）. Most （75.2%） of the complications occurred in the first 2 years of that operators used the ureteroscopy. Conclusions Strictly mastering surgical indications, strengthening preoperative training and mastering the surgical technique, taking correct measure is the key to reduce the failure rate and complications of ureteroscopy.