输尿管软镜鞘扩张法治疗输尿管狭窄合并结石初步体会

Clinical experiences of ureteral stricture with calculi treated by flexible ureteroscope sheath dilatation

目的探讨输尿管软镜鞘扩张法治疗输尿管狭窄合并结石的可行性。方法回顾性分析我院2017年3月至2019年8月输尿管狭窄合并结石的患者72例,其中男性30例,女性42例,平均年龄(49±9)岁,输尿管硬镜探查置入超滑导丝并确保在位后采用10~14 F软镜鞘内芯及输尿管软镜鞘逐级扩张,并使用输尿管软镜碎石,术后评估结石清除率及术后3、6、12个月输尿管再狭窄率。结果一期成功扩张并手术48例,20例一期置管后二期成功扩张并手术,4例更换术式,手术成功率94.4%(68/72),手术时间(65±24)min,Clavien分级(手术并发症分级)Ⅰ-Ⅱ级72例,Ⅲ-Ⅳ级0例,术后结石清除率94.4%(68/72),术后3个月、6个月、1年输尿管再狭窄率分别为5.6%(4/72),6.9%(5/72),8.3%(6/72)。结论输尿管软镜鞘扩张法是治疗输尿管狭窄合并结石安全、有效的方法。

Objective To investigate the feasibility of flexible ureteroscope sheath dilatation in the treatment of ureteral stricture with calculi.Methods A total of 72 patients with ureteral stricture and calculi were treated by flexible ureteroscope sheath dilatation from March 2017 to August 2019,30 patients were male,42 patients were female,average age(49±9)years.The rigid ureteroscopy was used for exploration,an indwelling guide wire was placed to introduce the sheath of the flexible ureteroscopy,dilation step by step.By the holmium laser,the stones were fragmented.The calculi clearance rate and restenosis rate were evaluated at 3,6 and 12 months after surgery.Results 48 cases were managed by one-stage operation,20 cases were managed by second-stage operation,4 cases of the patients had to convert into surgery approach,The success rate of operation was 94.4%(68/72).The operation time was(65±24)minutes,Clavien classification grade(Classification of surgical complications)℃-℃were occurred in 72 patients,grade℃-℃in 0 patient.Stone free rate was 94.4%(68/72).After 3 months,the recurrence of ureteral stricture rate was 5.6%(4/72),After 6 months,the recurrence of ureteral stricture rate was 6.9%(5/72),one year later,the recurrence of ureteral stricture rate was 8.3%(6/72).Conclusion The flexible ureteroscope sheath dilatation is safe and effective in the treatment of ureteral stricture with calculi.