输尿管镜碎石术后输尿管狭窄的治疗

Treatment of ureteral stenosis after ureteroscopic lithotripsy

目的研究输尿管镜碎石术后输尿管狭窄的治疗方法及效果。方法回顾性分析北京清华长庚医院2014年12月-2018年2月收治的输尿管镜碎石术后输尿管狭窄患者的临床资料。初次治疗、输尿管狭窄长度<2 cm的患者首选以内腔镜下治疗为主的手术方式(内腔镜下球囊扩张或球囊扩张+内切开)为内镜组,既往治疗失败或狭窄长度>2 cm的患者选择以尿路重建手术为主的治疗方式为腹腔镜/开放组,记录并观察患者术后发热、腰痛、留置输尿管支架管或肾造瘘管、超声、CT尿路造影、利尿肾图等情况。结果34例行内腔镜下治疗,11例行开放/腹腔镜尿路重建手术。内腔镜治疗病例中73.5%(25例)为初次治疗,尿路重建病例中63.6%(7例)术前有输尿管狭窄治疗史。内腔镜手术有效率44%,尿路重建术有效率76%,尿路重建术有效率为内腔镜治疗的1.73倍。结论虽然尿路重建手术有效率明显高于内腔镜下治疗,对于选择合适的病例,内腔镜手术仍可作为输尿管镜碎石术后输尿管狭窄的一线治疗。初次治疗可采用内腔镜治疗,有既往治疗史的患者则以尿路重建手术为主。

Objective To explore the methods and efficacy of treating secondary ureteral strictures after ureteroscopic lithotripsy.Methods Clinical data of patients with ureteral stenosis after ureteroscopic lithotripsy admitted to Beijing Tsinghua Changgung Hospital during Dec.2014 and Feb.2018 were retrospectively analyzed.Patients receiving initial treatment whose ureteral stenosis was less than 2 cm were enrolled into the endoscopic group(endoscopic balloon dilatation or balloon dilataion+internal incision),while those with previous treatment failure or stenosis length greater than 2 cm were enrolled into the ureteroplasty group.The postoperative fever,renal colic,indwelling of ureteral stent or nephrostomy tube,ultrasound,CT urography,diuretic scintigraphy were recorded.Results There were 34 cases in the endoscopic group(73.5%received initial treatment)and 11 cases in the ureteroplasty group(63.6%had a history of treatment of ureteral stenosis).The overall success rate of ureteroplasty was 76%,which was 1.73 times higher than that of endoscopic surgery(44%).Conclusion Although ureteroplasty is more effective than endoscopic surgery,endoscopic surgery can still be used as the first-line treatment of ureteral stenosis after ureteroscopic lithotripsy.Endoscopic treatment can be used for the initial treatment,while ureteroplasty is the main treatment option for patients with a history of previous treatment.