输尿管硬镜术中导致各种困难的原因及对策

Causes and countermeasures of various difficulties caused during rigid ureteroscopy

目的探讨输尿管硬镜术中的各种困难及应对措施。方法回顾性分析该院2015年3月-2018年5月收治的困难输尿管硬镜术的47例患者临床资料。结果13例输尿管口辨认困难者,通过试插导管、电切镜联合输尿管镜、沿肾造瘘管注入亚甲蓝等方法,寻及输尿管口,成功进镜;29例上镜困难,通过输尿管扩张、钬激光内切开、技巧性旋转、控制灌注液量和改变患者体位等方法,19例成功进镜,2例留置双J管,5例改行经皮肾镜,3例改开放手术;5例退镜困难,通过增加镇痛、肌松药物,润滑镜体,反复耐心旋转镜体,均成功退镜。结论输尿管硬镜术中困难原因复杂多样,术中应针对不同原因所致的困难采取相应对策,灵活运用各种技巧,提高手术成功率。

Objective To examine the causes of difficulties associated with rigid ureteroscopy and make the countermeasures.Methods We retrospectively analyzed the clinical data of 47 patients who were observed to have experienced difficulties during a rigid ureteroscopy from March 2015 to May 2018.Results We observed that 13 patients showed a difficulty in accurately locating the ureteral orifice.In these patients,catheter insertion trials,use of a resectoscope combined with ureteroscopy,and the creation of a fistula along the kidneys with methylene blue infusion were a few methods that were employed to eventually achieve successful ureteroscope insertion.In the 29 patients who experienced access difficulties and ureteral expansion,holmium laser incision,rotational techniques,control of perfusion volume,and changing the patient’s posture,among other such methods enabled a successful ureteroscopic procedure.Among these patients,successful ureteroscope access was achieved in 19 patients-indwelling double-J stents were inserted in 2,a percutaneous nephroscope was used in 5,and open surgery was performed in 3 patients.5 patients experienced difficulties with ureteroscope withdrawal.However,the ureteroscope could be successfully removed in all patients after increasing the dose of analgesics and muscle relaxants administered,lubricating the body of the ureteroscope,and/or repeated and patient rotation of body of the ureteroscope.Conclusion The causes of difficulties encountered during rigid ureteroscopy are complex and diverse.Based on the difficulties caused by different factors during surgery,the corresponding countermeasures need to be used in a patient.Additionally,flexible usage of various techniques can increase the success rate of surgeries.