顺行输尿管软镜在复杂上尿路疾病诊治中的应用

Anterograde Flexible Ureteroscopy in the Management of Complicated Upper Urinary Tract Disease

目的探讨顺行输尿管软镜在复杂上尿路疾病中的应用价值。方法 2007年1月～2010年7月应用顺行输尿管软镜诊治上尿路疾病23例,其中联合经皮肾镜诊治复杂性肾结石17例(1例伴上盏憩室结石),膀胱癌尿流改道后梗阻性疾病3例,后腹腔镜下输尿管切开取石术中输尿管软镜明确结石移位2例,诊断性质不明输尿管病变1例。结果 17例复杂性肾结石经皮肾镜下联合输尿管软镜镜检、碎石,结石清除率100%,术后4周复查KUB无结石残留,无术后并发症。3例输尿管肠段吻合口狭窄,狭窄环内切开扩张、输尿管结石碎石1例,术后6周软膀胱镜下经回肠代膀胱拔除双J管,拔管后3个月随访患侧肾积水无加重。2例后腹腔镜下输尿管上段结石切开取石术中结石移位,输尿管软镜镜检明确结石移行入肾盂,改开放手术治疗。1例尿道损伤闭锁膀胱长期造瘘术后,输尿管软镜下活检明确输尿管癌。结论顺行输尿管软镜诊断和治疗上尿路疾病是一种有效的、微创的方法,在复杂性肾结石、输尿管上段结石的联合诊治、尿流改道后并发症的治疗及输尿管病变的诊断和治疗中是安全的、实用的。

Objective To explore the value of anterograde flexible ureteroscopy for upper urinary tract disease.MethodsA retrospective review was performed on 23 patients who underwent anterograde flexible ureteroscopy for upper urinary tract disease from January 2007 to July 2010.Among the patients,17 cases had complicated renal calculi,including calculi in the upper calyceal diverticulum in one case,were selected to be treated by percutaneous nephrostolithotomy（PCNL） combined with anterograde flexible ureteroscopy lithotripsy.Flexible ureteroscopy was performed on 3 cases of uretero-intestinal anastomotic stricture after Bricker procedure.Two cases showed calculi displacement and 1 case had no confirmed diagnosis.Results The overall stone-free rate in the 17 cases with complicated renal calculi was 100%;KUB showed no residual stones at 4 weeks after the operation;no complication occurred in the patients.In the 3 cases who had anastomotic stricture,balloon dilation was performed on 2 patients,and the other received lithotripsy;double-J tube was withdrawn by using flexible ureteroscopy via the ileum at 6 weeks after the operation;none of them showed deteriorated hydronephrosis during a 3-month follow-up.The two patients who had displaced calculi received open surgery after flexible ureteroscope confirmed that the calculi had moved in the renal pelvis.Biopsy under flexible ureteroscope confirmed transitional cell carcinoma in one patient.Conclusion Anterograde flexible ureteroscopy is an effective,reproducible and minimally invasive method for diagnosis and therapy for upper urinary tract disease.