输尿管狭窄的腔内治疗

Endosurgical management of ureteral stricture

目的:探讨输尿管镜下钬激光内切开术治疗输尿管狭窄的可行性及有效性。方法:回顾分析23例输尿管狭窄患者的临床资料:男15例,女8例,年龄21～64岁,平均41岁;狭窄段长度0.3～1.5cm,平均0.8cm。均行经尿道输尿管镜下钬激光狭窄段内切开术,尽可能全层切开,放置双J管4～8周。结果:手术均顺利,手术时间4～25min,平均13min,出血量0～20ml,平均8ml;术后3天内拔除尿管出院。随访4～67个月,平均36.4个月,2例(8.7%)分别于术后16个月、28个月输尿管局部再狭窄再次行输尿管镜下钬激光内切开术治疗后治愈。结论:对于长度较短的输尿管狭窄行经输尿管镜腔内治疗,手术微创、安全、高效,恢复快,预后佳。

Objective： To evaluate the possibility and efficacy of endosurgical management （EM） for treatment of ureteral stricture（US）. Method：A retrospective study was done in 23 patients （ 15 men and 8 women） under- went EM for US with mean length 0.8 cm（0.3 cm to 1.5 cm）. Inside incision with ureteroscopic Holmium：YAG laser was performed at the extent including 0.5 cm proximal and distal to US, to full-thickness ureter. A double J stent was stayed for 4 to 8 weeks in all patients. Result：All 23 patients underwent successfully EM and discharged after 1 to 3 days stay without infection or other complications. The average procedure time was 13min （4 min to 25 min） and mean blood was 8ml （0 ml to 20 mD. During 4 to 67 months follow-up,no hydronepherosis was shown in 21 patients by ultrasonography. Two patients （8.7%）were performed re-EM for recurrent US, 16 months and 28 months after surgery, respectively. Conclusion： For patients with short length US, EM with Holmium： YAG laser may be a logical option with mini invasion, short hospital stay and good prognosis.