电切镜联合亚甲蓝在腺性膀胱炎中寻找困难输尿管开口中的应用

Application of Resectoscope Combined With Methylene Blue for Finding Difficult Ureteral Orifice in Cystitis Glandularis

目的 探讨电切镜联合亚甲蓝在腺性膀胱炎(cystitis glandularis, CG)中寻找困难输尿管开口的价值。方法2019年6月~2021年9月我们对13例CG合并困难输尿管开口膀胱内病变进行标准切除,然后薄层电切目标输尿管开口区,初步明确输尿管开口。膀胱灌注0.01%亚甲蓝溶液,在亚甲蓝视野中观察输尿管口喷尿情况。5 min后用生理盐水冲洗膀胱,找到外翻未染色的壁内段输尿管黏膜,插入导丝。更换输尿管镜确认输尿管腔,在导丝引导下置入双J管。结果13例(23侧)在亚甲蓝染色指引下成功置入双J管。手术时间37~178 min,中位时间72 min。术后4~6 d拔除导尿管。术后1~2 d复查腹部平片示双J管位置良好。围手术期无并发症发生。13例术后3个月膀胱镜检查见术区瘢痕组织形成,输尿管开口喷尿正常。结论 应用亚甲蓝染色指导术者识别CG的困难输尿管开口,是一种微创、高效的方法。

Objective To investigate the value of resectoscope combined with methylene blue for finding difficult ureteral orifices in cystitis glandularis(CG).Methods From June 2019 to September 2021,we performed standard resection of intravesical lesions in 13 patients with CG and difficult ureteral orifices,followed by thin-section resection of the target ureteral orifice area to initially identify the ureteral orifices.Intravesical instillation of 0.01%methylene blue solution was performed to observe ureteral orifice spraying in the methylene blue field.After 5 minutes,the bladder was rinsed with normal saline,the everted unstained mucosa was found in the ureteral wall,and the guide wire was inserted.The ureteroscope was replaced to confirm the ureteral lumen,and a double-J stent(DJS)was placed under guidance.Results The DJS was successfully placed in all the 13 patients(23 sides)under the guidance of methylene blue staining.The operation time was 37-178 min,and the median time was 72 min.The catheter was removed in 4-6 d postoperatively.Re-examinations of abdominal image at 1-2 d after surgery showed that the DJS was in good position.No perioperative complications occurred.Thirteen patients had scar tissue formation in the surgical area under cystoscopy 3 months after surgery and normal urine spraying from the ureteral orifice.Conclusion The application of methylene blue staining to guide the surgeon to identify difficult ureteral orifices in patients with CG is a minimally invasive and efficient method.