输尿管软镜在输尿管中上段结石合并下段狭窄中的应用

Application of flexible ureteroscope in the treatment of middle and upper ureteral calculi complicated with lower ureteral stricture

目的探讨输尿管硬镜治疗失败后采用输尿管软镜治疗输尿管中上段结石合并下段狭窄患者的安全性及疗效。方法分析2019年10月-2021年10月石河子大学医学院第一附属医院收治的经标准及细输尿管硬镜均治疗失败、改行输尿管软镜治疗的输尿管中上段结石合并下段狭窄的36例患者资料,平均年龄(46.2±13.2)岁,结石最大径平均(1.3±0.3)cm,记录并分析患者术中、术后及随访数据。结果36例患者均一期顺利完成手术,术中测量狭窄程度F6~8,仅能扩张至F9~11,狭窄平均长度(1.1±0.34)cm,术后无严重感染及出血等并发症发生。有2例患者失访,34例得到随访,且术后超声检查无明显肾积水。术后1、2、3个月的排石率分别为76.5%、88.2%、97.1%,1例结石残留患者于术后第3个月行二期输尿管软镜治疗,成功碎石并用取石网篮取出较大块碎石。结论输尿管中上段结石合并下段狭窄的患者在输尿管硬镜治疗失败后应用输尿管软镜治疗,可明显增加一期手术的成功率,且安全、有效。

Objective To explore the safety and efficacy of flexible ureteroscope in the treatment of upper and middle ureteral calculi complicated with lower ureteral stricture after the failure of rigid ureteroscopy.Methods Clinical data of 36 patients with middle and upper ureteral calculi and lower ureteral stricture treated with rigid ureteroscopy but failed during Oct.2019 and Oct.2021 were retrospectively analyzed.The patients average age was(46.2±13.2)years,and the maximum diameter of calculi was(1.3±0.3)cm.The intraoperative,postoperative and follow-up data were recorded.Results All 36 patients successfully completed first-stage operation.Intraoperatively,the stenosis degree was F6-8 and could be dilated to F9-11.The mean length of stenosis was(1.1±0.34)cm.No serious postoperative complications such as infection or bleeding occurred.Two patients were lost and 34 patients were followed up.There was no obvious hydronephrosis on ultrasound examination.The stone removal rates were 76.5%,88.2%and 97.1%,respectively,in months 1,2 and 3 after operation.One patient with residual stones underwent secondary ureteroscopy in month 3 and large stones were removed with stone removal basket.Conclusion In patients with middle and upper ureteral calculi and lower ureteral stricture,after the failure of rigid ureteroscopy,flexible ureteroscope is safe and effective,and can significantly increase the success rate of first-stage surgery.