输尿管镜手术入镜困难的原因与对策

Analysis of the diffculties in accessing into ureter during rigid transurethral ureteroscopy and management

目的:探讨输尿管镜手术时上镜困难的原因与对策。方法:应用输尿管硬镜逆行治疗312例输尿管结石,46例入镜困难,进行控制液压灌注泵压力、改变患者体位、扩张输尿管等方法处理。结果:成功入镜31例,9例改开放手术,4例插管后行ESWL。结论:熟悉输尿管的解剖与病理生理特点,入镜成功的关键在于手术者的操作技巧与经验。

Objective To analysis the causes of the diffeulties in accessing into ureter during rigid transurethral ureteroscopy and management. Methods Rigid transurethral ureteroseopy was conducted in 312 patients with ureteral stones.Difficulties of ueteroscope in accessing into ueter was encountered in 46 patients and overcame by adjusting the pressure of hydraulic irrigation, changing the position of patient,or dilating the ureter.Results Of the 46 patients with difficult retrograde access,successful ureteroscopy was achieved in 31 patients,conversions to open ureterolithotomy were required in 9 patients and ESWL were conduncted after inserting ureter catheter in 4 patients with.Conclusion The key to successful retrograde access of rigid ureteroscope lies in the acquaintance with normal and pathologic anatomy and physiology of the ureter and urologist＇ s operative skills and experience.