输尿管结石合并狭窄的治疗策略

Therapeutic strategies for ureteral calculi accompanied with ureteral stricture

目的探讨输尿管结石合并狭窄的治疗策略。方法选择2011年5月至2014年9月间进行治疗的输尿管结石合并狭窄的患者91例,总结分析患者采用的治疗方案以及随访术后恢复的情况。结果 91例患者中,72例（79.12%）成功完成输尿管镜检查和碎石治疗,5例患者因输尿管膀胱开口未能视及而终止手术,14例患者因输尿管管腔闭塞不能通过输尿管镜而终止手术。14例患者中其中有7例患者二期再行输尿管镜检查手术治疗获得成功。患者手术治疗时间为15~65 min,平均时间为（31.6±23.5）min,住院天数为3~9 d,平均住院（5.6±2.8）d。术后留置输尿管支架管时间为3~12周,平均为（4.6±2.8）周。手术中未出现较为严重的输尿管撕脱损伤及大出血。术后随访时间为5~24个月,平均为（8.6±4.7）个月。65例（71.4%）患者肾、输尿管积水完全治愈,13例（14.3%）患者仅有轻度肾脏积水,13例（14.3%）患者因仍存在明显的肾脏和输尿管积水而再次实施手术。其中2例患者因较为严重的输尿管狭窄病变,长期更换输尿管支架管治疗。5例患者因输尿管镜腔内治疗未获成功而采用开放性手术治疗。4例患者进行了第2次的输尿管镜腔内治疗。还有2位患者未采用进一步的治疗。结论输尿管结石合并狭窄患者应当及时解除输尿管的梗阻,输尿管狭窄扩张合并输尿管支架管的置入可以有效地解除输尿管梗阻,仅当狭窄的范围较大或狭窄较为严重的时候需要进行开放性手术或者重复输尿管镜手术。

Objective To retrospectively analyze the treatment methods and the results of ureteral calculi accompanied with ureteral calculi. Methods Clinical data of 91 patients with ureteral calculi and ureteral stricture admitted from May 2011 to September 2014 were retrospectively analyzed.Results Among 91 patients,72 patients（ 79. 12%） successfully completed the treatment; 5 patients failed due to the severe stricture of opening of ureter and 14 patients failed due to the ureteral obstruction,in which 7 cases underwent re-operation successfully. The mean operation time was（ 31. 6 ± 23. 5） min（ 15-65 min）; the mean length of hospital stay was（ 5. 6 ± 2. 8） days（ 3-9 d）; and the mean duraiton of indwelling ureteral stent was（ 4. 6 ± 2. 8） weeks（ 3-12 weeks）. There was no severe ureteral avulsion injury and bleeding during the operation. Postoperative follow-up time was 5 to24 months（ 8. 6 ± 4. 7） months. Sixty five patients（ 71. 4%） were completely cured,13（ 14. 3%）patients had mild hydronephrosis. Among 13（ 14. 3%） patients with kidney and ureter obstruction after surgery,2 cases with severe ureteral stenosis underwent a long-term replacement of ureteral stents,5 cases were treated with open surgery,4 cases were treated with ureter endoscopy for the second time,while 2 cases took no further treatment. Conclusion Patients with ureteral calculi and ureteral stricture should be treated simultaneously. The ureteral obstruction can be relieved effectively by the insertion of the ureteral stent. Open surgery or repeated endoscopic procedures are required only if the large range or seriously ureter stricture occur.