输尿管硬镜入镜困难的原因与处理方法

Analysis of the difficulties in ureter access during rigid transurethral ureteroscopy and management

目的探索传统输尿管硬镜在成人手术中入镜困难的原因及处理方法。方法 2011年1月至2012年12月共行成人输尿管硬镜手术486例,其中42例发生入镜困难,均采用相应方法处理。结果 20例采用技巧性旋转和调整镜体入镜成功,11例采用调节体位输尿管扩张等方法入镜成功,9例采用边碎石边入镜成功,1例插管后行二期输尿管手术,1例中转开放性手术。结论发生输尿管硬镜入镜困难的主要原因是输尿管壁间段发生了各种类型的解剖结构变异,能顺利入镜的要点是熟悉解剖结构变异与掌握各种操作技巧。

Objeotive To explore the causes and treatment methods of difficulties in accessing into ureter during rigid adult ureteroscopy. Methods Total 486 cases underwent transurethral ureteroscopy, the data were evaluated retrospectively from January 2011 to December 2012. 42 cases had difficulties in adult ureteroscope into ureter in operation. Results Among 42 cases, 20 cases were completed successfully by rotation skills and changing ureteroscope, 11 cases by changing the positions of the patients and dilating the ureter, 9 cases by holmium laser lithotripsy when ureteroscope inserted, 1 case was left with double J ureteral operation for the second surgery, 1 case was converted to open operation. Conclusion The causes of difficulties in accessing into ureter during conventional adult ureteroscopy include varieties of anatomic structure that were found in the intramural ureter. The key to successful retrograde access to the rigid ureteroscope lies in the acquaintance with normal and pathologic anatomy and physiology of the ureter and the urologist＇s operative skills and experience.