输尿管扩张球囊导管联合钬激光治疗输尿管结石合并远端输尿管狭窄的疗效观察

The ureteral dilatation balloon catheter combined with holmium laser in the treatment of ureteral calculi with distal ureteral stricture

目的探讨输尿管扩张球囊导管在输尿管镜钬激光治疗输尿管结石合并远端输尿管狭窄的应用价值,评估其疗效及安全性.方法2018年8月至2019年5月对输尿管镜经检查或治疗过程中输尿管镜无法正常通过的良性输尿管狭窄17例.所有患者采用全身麻醉,先插入5°Wolf 6.0/7.5Fr输尿管镜进行检查,发现输尿管狭窄,输尿管镜无法正常通过.遂使用输尿管扩张球囊导管扩张输尿管狭窄段,在扩张球囊导管引导下继续上行输尿管镜,收缩球囊,沿结石侧方将球囊置入输尿管结石近端后充盈球囊封堵结石,钬激光碎石.视术中情况酌情留置DJ管.结果输尿管镜检查中发现输尿管狭窄患者17例,输尿管下段狭窄11例(其中输尿管口狭窄6例),输尿管中段狭窄4例,输尿管上段狭窄2例.其中15例行球囊扩张后顺利进镜,14例Ⅰ期顺利碎石,其中6例未留置DJ管,术后无肾绞痛发作,无腰痛等不适,8例留置DJ管,术后2~4周拔除;另1例输尿管结石逃逸至肾盂,留置DJ管2周后行输尿管软镜下碎石成功;2例输尿管长段狭窄,球囊扩张后输尿管仍无法通过,留置DJ管4周后再行输尿管镜手术顺利进镜.17例患者均随访>6个月,未发现输尿管狭窄复发.结论输尿管扩张球囊导管联合钬激光是治疗合并远端输尿管狭窄的输尿管结石值得推荐的安全有效方法,对输尿管损伤小、成功率高,减少Ⅱ期手术.

Objective To explore the value of ureteral dilated blloon catheter in ureteroscopic holmium laser treatment of ureteral calculi with distal ureteral stricture,and to evaluate its efficacy and safety.Methods All the patients were anesthetized by general anesthesia and inserted by 5。wolf 6.0/7.5fr ureteroscope for examination from August 2018 to May 2019.17 cases of benign ureteral stricture whose Ureter were found to be narrow and unable to pass normally were included in the study.Then,the ureteral stricture was dilated with ureteral dilated ballon catheter.Under the guidance of the dilated balloon catheter,the ureteroscope was continued to go up,the balloon was contracted and placed in the proximal end of the ureteral stone along the side of the stone,and then flld with the balloon to block the stone,and do holmium laser lithotripsy.The DJ tube should be retained according to the situation during operation.Results 17 cases of ureteral stricture,11 cases of lower ureteral stricture(6 cases of ureteral orifice stricture),4 cases of middle ureteral stricture and 2 cases of upper ureteral stricture were found in the first ureteroscopy.Among them,15 cases were treated sucessfully after balloon dilatation,14 cases were treated with one-stage ltotripsy suessfully,among which 6 cases had no DJ tube,no renal colic attack,no low back pain and other discomfort,8 cases had DJ tube,which was removed 2-4 weeks after operation;another case had ureteral calculi escaping to the renal pelvis,which was treated with ureteroscopic soft lithotripsy sucssfully after 2 weeks with DJ tube;Ureteroscopy was performed in 2 cases with long ureteral stricture whose ureter could not pass through after balloon dilatation.17 patients were followed up for more than halfa year,no recurrence of ureteral stenosis was found.Conclusion Ureteral dilated balloon catheter combined with holmium laser is a safe and effective method for the treatment of ureteral calculi with distal ureteral stricture.It has small ureteral injury and high success rate,and reduces the incidence of secondary operation.