电切镜与输尿管镜在输尿管中下段结石并输尿管开口进镜困难中的应用

Resectoscope and ureteroscope in the treatment of middle-lower ureteral calculi accompanied with difficulty in entering ureteral opening

目的评估电切镜与输尿管镜在输尿管中下段结石合并输尿管开口进镜困难中的安全性及有效性。方法回顾性分析2008年3月至2019年12月中国人民解放军南部战区总医院收治的40例输尿管中下段结石并输尿管开口进镜困难患者的临床资料。所有患者术中输尿管镜均无法进入输尿管开口,采用电切镜斜面切开输尿管开口,置入斑马导丝,输尿管镜顺利进入输尿管腔内,上行至结石段输尿管进行钬激光碎石。结果40例患者均顺利通过电切镜与输尿管镜解决输尿管开口进镜困难及结石处理。平均手术时间(27±6)min,术中失血量(7.0±1.4)ml,术后住院时间(3.6±0.9)d。术后一周复查腹部平片提示输尿管双J管位置良好,结石清除率为97.5%。术后随访(4.3±1.0)个月,复查静脉泌尿系造影及膀胱尿道造影,提示无输尿管狭窄及返流。结论采用电切镜与输尿管镜在输尿管中下段结石并输尿管开口进镜困难治疗中安全有效,可提高微创手术成功率,值得推广。

Objective To evaluate the safety and efficacy of resectoscope and ureteroscope in the treatment of middle-lower ureteral calculi accompanied with difficulty in entering ureteral opening.Methods Forty cases of middle-lower ureteral calculi with difficulty in entering ureteral opening patients were admitted in General Hospital of Southern Theatre Command of China People's Liberation Army from March 2008 to December 2019.All patients underwent transurethral resection of the ureter opening,under the guidance of the guide wire,the ureteroscope entered the ureter,and then holmium laser lithotripsy under ureteroscope was performed.Results All patients were completed the operations successfully.The average operative time was(27±6)min,intraoperative blood loss was(7.0±1.4)ml,the duration of hospitalization postoperative was(3.6±0.9)d.The abdominal plain film was examined and D-J stent was in good position one week after operation,the stone clearance rate was 97.5%.All patients were followed up(4.3±1.0)months after the operations,and intravenous urography and cystourethrography examination showed no ureteral stenosis and reflux.Conclusions Resectoscope and ureteroscope is safe and effective in the treatment of middle-lower ureteral calculi accompanied with difficulty in entering ureteral opening,it can increase the success rate of endoscopic surgeries and worthy of promotion.