腔内技术治疗输尿管狭窄、闭锁443例临床分析

CLINICAL ANALYSIS OF 443 CASES OF URETERAL STRICTURE AND ATRESIA WITH ENDOUROLOGICAL TECHNIQUE

目的探讨腔内泌尿外科技术治疗输尿管狭窄、闭锁的疗效和安全性。方法对443例采用腔内泌尿外科技术治疗的输尿管狭窄、闭锁患者资料进行回顾性分析。结果对443例患者全部采用不同的腔内输尿管腔内技术治疗,其中:输尿管镜下直视扩张218例,导管扩张63例,输尿管球囊扩张15例,采用钬激光或线状电针电凝输尿管炎症性息肉引起的狭窄33例,钬激光内切开25例,线状电刀内切开47例,输尿管镜下直视冷刀切开术35例,输尿管闭锁复通7例。所有病例均一次手术成功,成功率100%。术后有3例输尿管狭窄患者肾积水复发。结论利用腔内技术处理输尿管狭窄疗效好,创伤小,安全性高,费用低。钬激光及线状电切电凝对炎症和息肉引起的狭窄,疗效较好。输尿管镜直视下扩张术结合术,对较轻的输尿管狭窄疗效好;输尿管套管扩张输尿管下段狭窄,效果好。输尿管冷刀切开术对较长段的严重狭窄或闭锁疗效更好。以上腔内技术处理狭窄,术后结合放置双J管引流、慢性扩张效果更好。

Objective To discuss the effectiveness and safety of using endourological technique in patients with ure- teral stricture and atresia. Methods The clinical data of 443 cases of ureteral stricture and atresia treated by endourological technique were reviewed retrospectively. Results Among 443 cases, 218 were treated with dilation on nreteroscopy under direct vision, 63 with catheter dilation, 15 with ureteral balloon dilation, 33 with stenosis caused by inflammatory polyps trea- ted with holmium laser coagulation or linear electro - acupuncture, 25 with holmium laser coagulation, 47 with linear electro - acupuncture, 35 with cryoscalpel under direct vision, and 7 with ureteral atresia recanalization. All cases were cured upon one operation and the success rate was 100%. Hydronephrosis after operation relapsed in 3 patients with ureteral stricture.. Conclusion Ureteral stricture with endourological technique has advantages of good curative effects, less trauma, higher safeness and lower cost. It is effective both in the treatment of ureteral atresia caused by inflammation and polyp with holmium laser coagulation and linear electro - acupuncture and in the treatment of less serious atresia with dilation on ureteroscopy un- der direct vision. As for the most serious ureteral stricture or atresia, it is better to use cryoscalpel under direct vision. After above treatment, it is better to combine with Double J tube for drainage and chronic expanding.