输尿管镜下钬激光切开结合X光引导下输尿管球囊扩张治疗输尿管狭窄

Research of holmium laser incision combined with X - ray guided balloon dilation in treatment of ureterostenosis under ureteroscope

目的探讨经输尿管镜下钬激光切开结合X光导引下输尿管球囊扩张治疗输尿管狭窄的疗效。方法对2008年2月至2015年1月使用经输尿管镜下钬激光切开结合X光导引下输尿管球囊扩张治疗的49例输尿管狭窄的患者进行回顾性分析。术中使用斑马导丝通过狭窄部，在导丝引导下使用钬激光切断狭窄环，而后在X光引导下使用输尿管球囊扩张，扩张后再置入另外一根斑马导丝，而后放入2根5号双J管。结果49例患者均安全完成手术，围手术期有5例患者出现发热，体温超过38．5℃，经抗炎治疗后出院。余无手术并发症。随访1年后，42例患者治愈，5例好转，2例术前有狭窄段上端输尿管迂曲的患者无效。结论采用钬激光切开结合输尿管球囊扩张治疗有明确狭窄环的输尿管狭窄，疗效好，在输尿管狭窄治疗中很有前景。但对于合并输尿管狭窄上端输尿管迂曲扩张的患者应慎用。

Objectives To explore the efficacy of holmium laser incision combined with X - ray guided balloon Dilation in treatment of ureterostenosis under ureteroscope. Methods A total of 49 patients with ureteric stenosis were analyzed retrospectively in our hospital from February 2008 to January 2015. All the patients were treated by a combined therapy. Results All patients were successfully completed surgery,except for 5 cases who developed fever（ over 38.5℃） ,others had no complication. After one year of follow - up, 42 patients were totally cured, 5 patients were improved, and 2 patients with upper ureter circuity were inefficient. Conclusions The holmium laser incision combined with X - ray guided balloon Dilation in treatment of ureterostenosis under ureteroscope is effective and have a broad clinical prospects. However, in patients with upper ureter circuity, it should be cautiously used.