钬激光内切开术治疗输尿管肾盂连接部狭窄的疗效观察(附24例报告)

Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser on the treatment of ureteropelvic junction obstruction(Report of 24 cases)

目的:探讨输尿管镜下钬激光(Ho:YAG激光)内切术开治疗肾盂输尿管连接部狭窄的疗效。方法:采用经输尿管镜Ho:YAG激光内切开术治疗24例肾盂输尿管连接部狭窄患者,术后平均留置双J管6周,每间隔3～6个月行超声、排泄性尿路造影及肾图检查。结果:平均随访10个月,20例临床症状缓解,影像学检查提示内切开段造影剂通过良好,治疗成功;4例治疗失败者再次行Ho:YAG激光内切开术,其中2例获得满意结果;无一例发生手术并发症。结论:输尿管镜下Ho:YAG激光内切开术对于原发性和继发性输尿管肾盂连接部狭窄是一种安全、有效、微创的治疗方法。

Purpose: To defined the safety and efficacy of retrograde ureteroscopic endopyelotomy using the Holmium:YAG laser on the treatment of ureteropelvic junction obstruction. Methods:Twenty four cases of uret-eropelvic junction obstruction were treated with retrograde ureteroscopic endopyelotomy using the Holmium: YAG laser. Postoperatively a ureteral stent remained indwelling for an average of 6 weeks. All patients were followed with serial ultrasound, excretory urography and renal scan at 3 to 6-month intervals. Results:Foliowup was available in all cases at a means of 10 months. Success, defined as improved drainage on radiographic study and absent clinical symptoms, were achieved in 20 patients. Repeat laser incision resulted in a successful outcome in 2 of the 4 treatment failures. There were no acute surgical complications. Conclusions.- Retrograde ureteroscopic endopyelotomy with the Holmium : YAG laser is a safe and minimally invasive therapy for primary and secondary ureteropelvic junction obstruction.