不同腔镜技术治疗输尿管狭窄的体会

Different cavity techniques for the treatment of ureteral stricture

目的探讨经尿道输尿管镜球囊扩张与腔内钬激光内切开术以及肾造瘘顺行球囊扩张治疗输尿管狭窄的疗效及临床应用价值。方法分析2009年12月～2012年1月来院手术的输尿管狭窄病人共40例,分别采用经输尿管镜球囊扩张与腔内钬激光治疗及肾造瘘顺行球囊扩张三种不同术式治疗输尿管狭窄患者,评价其治疗效果。结果经输尿管镜球囊扩张15例,手术后随访3月至半年不等,治愈14例,复发1例。腔内钬激光治疗15例,手术后随访3月至半年不等,治愈11例,复发4例。肾造瘘顺行球囊扩张10例,手术后随访3月至半年不等,治愈9例,有效1例,复发1例。所有病例均出现不同程度血尿。结论经尿道球囊扩张术与腔内钬激光内切开及肾造瘘顺行球囊扩张治疗输尿管狭窄均可取得较好的治疗效果,腔内钬激光治疗复发率相对较高,输尿管镜球囊扩张术对患者损伤轻,无严重并发症,肾造瘘顺行球囊扩张对手术医师的技术要求较高,费用较大。

Objective To explore the efficacy of ureteroseopy and Holmium laser and Renal colos- tomy in the treatment of ureteral stricture. Methods 40 patients ureterostenos was received ureterosco- py and Holmium laser and Renal colostomy. All cases had hemorrhage in different degrees. One sten t （F7）was placed in the ureter after the operation and left indwelling for 3 months. Ultrasound and Intra- venous pyelogram were performed just after extubation and 3 month later. Results Of the 40 cases, 34 cases were successful, 6 cases were unsuccessful. Conclusions Ureteroscopy, ureteroseopy, Holmium laser and Renal colostomy are safe, effective and minimally invasive to treat ureteral stricture.