利用输尿管软镜处理双J管拔除困难的方法

Management of pulling out the stuck double-J ureteral stents by flexible ureteroscopy

目的:探讨利用输尿管软镜处理双J管拔除困难的方法。方法:回顾性分析我院2013年6月～2017年5月收治的输尿管双J管拔除困难患者6例,其中男2例,女4例;年龄35～65岁,平均42岁;上尿路结石手术后长期滞留双J管3例,留置双J管时间分别为2个月、8个月、2年,3例双J管上布满结石,无法行膀胱镜取出,予行输尿管镜下钬激光碎石术,击碎附着在双J管上的结石,在输尿管上段将双J管烧断,改用输尿管软镜,在肾盂内将近端双J管上附着的结石击碎,用套石篮将残端双J管取出。另3例患者因肾盂结石拟行输尿管软镜手术,术前留置双J管行输尿管预扩张,双J管留置时间2周,在输尿管软镜术前拔除双J管时发现双J管被肾盂结石卡住无法拔除,予输尿管镜下用钬激光在肾盂出口位置烧断双J管,更换输尿管软镜行输尿管软镜钬激光碎石术,击碎结石后用套石篮取出残留双J管。结果:6例患者均顺利完成手术,无出血,无输尿管损伤,术后再次留置双J管,2～4周后拔除,无结石残留,随访1～2年,无输尿管狭窄。结论:双J管嵌顿后先用钬激光在近端将其烧断,再用输尿管软镜取出残端,可有效避免输尿管损伤。

Objective:To solve the method of difficulty of pulling out the double-J ureteral stents by flexible ureteroscopy.Method:The clinical data of six patients whose double-J ureteral stents were difficult to be pulled out were retrospectively analyzed.Two men and four women were aged 35 to 65(mean,42)years old.The reason of difficulty to pull out the double-J ureteral stents in three patients was that the stents were indwelt for long time(from 2 to 24 months).The stents were encrusted with stones and could not be pulled out by cystoscopic surgery.Ureteroscopic lithotripsy was performed in the three patients.The double-J ureteral stents were broken in proximal ureter by holmium laser after the encrusted stones were removed.The residual stents were extracted by flexible ureteroscopy.The reason of difficulty to pull out the double-J ureteral stents in another three patients was that the stents were stuck with stones in the renal pelvis.The double-J stents were broken by ureteroscopic surgery with holmium laser in the proximal ureter and then we pulled out the distal ureteral stents.Flexible ureteroscopic lithotripsy was performed after that and the residual double-J stents were pulled out by flexible ureteroscopicy.Result:All the patients’double-J stents were pulled out successfully.No bleeding or injury in ureter occurred during the operation.Double-J ureteral stents were indwelt again after the operations.The stones were free.All the patients were followed up for 1-2 years and no ureteral constriction was found.Conclusion:Flexible ureteroscopy can be used to solve the stuck double-J ureteral stents and avoid the injury effectively in ureter.