斜仰侧卧改良截石位腔内双镜联合治疗输尿管狭窄

Dual Endoscopy in Modified Oblique Supine Lithotomy Position for Ureteral Stricture

目的探讨斜仰侧卧改良截石位腔内双镜（输尿管镜＋经皮肾镜）联合治疗输尿管狭窄的临床疗效。方法对12例输尿管狭窄患者采用斜仰侧卧改良截石位腔内双镜联合治疗。结果 11例患者顺利通过输尿管狭窄段行扩张术治疗（10例行球囊扩张,1例行导管扩张）,扩张后皆成功置入双J管;1例未成功者通过狭窄端,留置肾造瘘管引流尿液后,Ⅱ期行腹腔镜下输尿管狭窄段切除＋端端吻合术。术后12例患者均出现少量血尿,经对症处理后1-2d消失,术中术后均无明显并发症。12例患者术后均随访3-12个月,10例患者肾积水明显缓解,2例无明显缓解。结论采用斜仰侧卧改良截石位腔内双镜联合治疗输尿管狭窄患者,能明显提高通过狭窄段的成功率和手术安全性。

aObjective To investigate the clinical effect of dual endoscopy（ureteroscopy＋ percutaneous nephroscopy）in the modified oblique supine lithotomy position on ureteral stricture.Methods Twelve patients with ureteral stricture were treated with dual endoscopy in the modified oblique supine lithotomy position.Results The ureteral dilatation was performed and double-J catheter was placed successfully in 11patients（balloon dilatation in 10 and catheter dilatation in 1）.The laparoscopic resection of strictured ureter and end-to-end anastomosis were performed after nephrostomy drainage in 1patient who failed to respond to ureteral dilatation.All the 12 patients had small amount of blood in the urine,which disappeared 1-2days after symptomatic treatment.No obvious complications occurred during and after operation.After 3-12 months of follow-up,hydronephrosis was obviously relieved in 10 patients,but was not changed in 2patients.Conclusion The dual endoscopy in the modified oblique supine lithotomy position can improve the success rate of passing through stricture and the safety of operation in patients with ureteral stricture.