两种输尿管扩张方法治疗输尿管下段狭窄的效果对比

Comparative study on two methods of dilatation in the treatment of lower ureteral stricture

目的探讨两种不同扩张输尿管的方法在输尿管下段狭窄治疗中的效果。方法回顾性研究分析2010～2017年收治的36例输尿管下段狭窄合并输尿管中下段结石,在做输尿管镜下碎石时发现输尿管狭窄,分别采取直视下输尿管钳撑开缓慢扩张法和球囊扩张法。其中男20例,女16例。年龄20～71岁,平均45岁。输尿管下段结石者22例,输尿管中段结石者14例,结石最大径为6～20 mm,平均11 mm,患侧肾功能轻度受损者6例,中度受损者27例,重度受损者3例。术中均用Wolf F 8/9.8输尿管镜入镜失败。将患者随机分成两组,A组19例,运用直视下输尿管钳撑开缓慢扩张法扩张输尿管;B组17例,运用球囊扩张法扩张输尿管,最终两组经过扩张后均能顺利入镜并碎石成功。留置双J管6周后反院拔管并入镜输尿管下段镜检狭窄情况。结果两组扩张对输尿管均有不同程度损伤,轻度损伤如粘膜撕裂A组高于B组,较重输尿管损伤如肌层撕裂、输尿管穿孔A组偏低。A组手术时间短于B组,术中出血及术后疼痛情况两组比较差异无统计学意义(P>0.05)。6周后输尿管镜检均能顺利入镜,穿孔位置黏膜光滑。结论两种扩张输尿管方法均可安全有效的治疗输尿管下段狭窄,为输尿管结石腔内碎石提供保障,其中输尿管钳缓慢扩张法是在直视下缓慢进行的,相对球囊非直视下扩张引起输尿管撕裂、穿孔几率小,并且费用低廉,适合基层医院开展,为输尿管狭窄合并输尿管结石患者提供新的有效治疗方法。

Objective To evaluate the efficacy of two different dilatation methods in the treatment of lower ureteral stricture.Methods 36 cases of lower ureteral stricture with co-existent ureteral calculi at middle-lower segment treated from 2010 to2017 in our hospital were retrospectively analyzed, and we adopt either slow dilatation method with ureteral forceps under direct vision or balloon dilation method. There were 20 males and 16 females, ages ranging from 20 to 71 with an average of 45 years. 22 cases had ureteral calculi at lower segment and 14 at middle segment, and the stone size ranged from 6-20 mm, with the average diameter of 11 mm. As for the renal function, it was mildly impaired in 6 cases, moderately impaired in 27 cases and severely damaged in 3 cases. In the operation, Wolf F 8/9.8 ureteroscopy＇s access to ureter failed. The abovementioned patients were randomly divided into two groups, 19 cases in group A were treated with slow dilatation method with ureteral forceps under direct vision and 17 cases in group B with balloon dilation method, and ureteroscopy successfully gained access to ureter in both groups after dilation. The D-J tubes were removed 6 weeks after the operation and microscopic examinations were performed in the lower segment of the ureter to check the stricture condition. Results Two dilatation methods both caused damages to the ureter to varying degrees, with the frequency of mild injuries, such as the tear of the mask, higher in group A while that of severe ureteral injuries, such as muscle laceration and ureteral perforation, higher in group B. The operation time of group A was significantly shorter than that of group B, and there was no significant difference in intraoperative hemorrhage and postoperative pain between the two groups. After 6 weeks, ureteral microscopies were performed successfully, and the mucosae at perforation point were smooth. Conclusion Two methods of dilatation of the ureter are safe and effective in the treatment of lower ureteral stricture and provide guarantee for the intracavity gravel in ureteral. Compared with balloon dilatation method, dilatation method with ureteral forceps, performed slowly under direct vision, has low probability of ureteral tear or perforation and is low in operative cost, therefore an effective treatment method for patients with ureteral stricture and co-existent ureteral calculi.