输尿管镜技术临床应用637例报告

目的总结输尿管镜技术的临床应用,探讨该技术的应用价值。方法回顾性分析637例（次）肾和输尿管结石、尿道狭窄、输尿管狭窄、尿道断裂、尿道结石等患者采用输尿管镜相关技术进行治疗的效果。结果输尿管镜下碎石术治疗输尿管结石523例,碎石成功率93.1%,其中在门诊局麻条件下完成78例,碎石成功率85.9%;行改良输尿管镜下筋膜扩张器治疗尿道狭窄23例,均顺利扩张,3例狭窄因狭窄段较长,后期改冷刀内切开联合电切术治愈;行微造瘘经皮肾镜碎石治疗肾结石、输尿管上段结石36例次,术后残石率19.4%;行输尿管镜下尿道会师术治疗后尿道断裂2例,输尿管镜下碎石治疗尿道结石16例,输尿管镜检查35例及输尿管镜扩张治疗输尿管狭窄2例均取得成功。结论输尿管镜相关技术适合治疗泌尿外科多种疾病,治疗效果良好,可广泛推广应用。     

输尿管镜诊治输尿管疾病222例体会

目的探讨输尿管镜诊治输尿管疾病的效果. 方法对222例输尿管疾病患者,应用输尿管镜联合气压弹道碎石治疗输尿管结石176例,取输尿管异物3例,诊治输尿管梗阻43例. 结果 176例(187侧)结石患者中170例(181侧)治疗成功,成功率96.8%;3例输尿管异物均顺利取出;43例输尿管梗阻患者中,39例为输尿管结石,均成功治疗,2例为输尿管狭窄予扩张治疗,2例为输尿管息肉予电灼治疗. 结论输尿管镜术诊治输尿管疾病,疗效确切,患者痛苦少,术后恢复快,是诊疗效果较为确切的泌尿外科微创技术.     

妊娠期肾积水的诊治（附87例报告）

目的：探索妊娠期合并肾积水的原因和治疗方法。方法：87例妊娠合并肾积水患者中69例（79％）采用内科保守治疗,11例（12％）采用膀胱镜下输尿管置管,8例（9％）输尿管镜术＋弹道碎石的方法治疗。结果：87例中肾绞痛症状均得到缓解,肾盂积水不同程度减少,86例治疗后顺利完成妊娠,1例因恐惧药物和手术影响胎儿自行终止妊娠后完成输尿管镜碎石。结论：轻度和中度妊娠期肾积水合并肾绞痛、尿路感染者经保守治疗大部分可以获得缓解。妊娠合并肾绞痛反复发作或重度肾积水的患者采用经膀胱镜输尿管置双J管引流术效果良好;输尿管结石妊娠患者输尿管镜弹道碎石效果可靠,生理干扰少,损伤小,对胎儿是比较安全的。     

输尿管镜术在输尿管阴性结石诊断和治疗中的应用(附40例报告)

目的探讨输尿管镜术治疗输尿管阴性结石的效果。方法对40例经KUB、B超、IVU或逆行造影检查疑为输尿管阴性结石患者,应用输尿管镜术确诊,并配合气压弹道取石碎石治疗。结果38例顺利进镜,其中15例结石<0.5 cm者,直接镜下钳夹取石,23例结石直径>0.5 cm者经气压弹道碎石,1例尿道狭窄、1例输尿管开口异常者进镜失败改行开放手术及ESWL治疗。结论输尿管镜术在输尿管阴性结石的诊断和治疗中具有重要作用。     

输尿管镜气压弹道碎石治疗输尿管结石(附132例报告)

目的探讨输尿管镜气压弹道碎石治疗输尿管结石的疗效。方法2001年3月至2005年3月132例输尿管结石患者采用输尿管镜气压弹道碎石治疗。其中男性88例,女性44例,年龄19-82岁,平均42岁。结石位于输尿管上段10例,中段24例,下段86例,单发结石104例,多发结石28例。结石横径3-12 mm,纵径3-24 mm;平均6.3 mm×8.6 mm。肾结石ESWL后形成输尿管石街12例。结果132例输尿管结石粉碎率92.4%(122例)。一次彻底排石成功率81.1%(107例)。10例未能给予气压弹道碎石,其中6例转为开放手术,4例改ESWL。结论输尿管镜气压弹道碎石术治疗输尿管结石创伤小、成功率高、并发症少。     

微创经皮肾取石术结合软式输尿管镜治疗肾鹿角形结石34例报告

目的:探讨微创经皮肾取石术(mPCNL)结合软式输尿管镜治疗肾鹿角形结石的临床疗效。方法:回顾分析2010年1月～2011年1月应用mPCNL结合软式输尿管镜治疗肾鹿角形结石患者34例,所有患者均行F18通道取石,其中单通道19例,双通道15例。结果:34例患者,19例单通道一期和分期mPCNL共26次;15例双通道一期和分期mPCNL共21次。平均手术时间130min;平均失血量120ml,4例需要输血,1例术后大出血,行超选择性肾动脉栓塞术。结石清除率85.3%(29/34)。结论:微创经皮肾取石术结合软式输尿管镜可减少穿刺通道和增加结石清除率。     

原发性输尿管息肉17例诊疗分析

目的探讨原发性输尿管息肉的诊断与治疗方法。方法回顾性分析1995~2007年收治的17例原发性输尿管息肉患者的临床资料,并结合文献讨论其诊断与治疗方法。结果17例患者中,肾及输尿管大部切除术2例,输尿管病变段切除肾盂成形术3例,病变段切除输尿管再吻合术9例,3例行输尿管镜下息肉切除。全部病例均获病理证实。术后随访6～24月,未发现息肉复发与恶变。结论静脉肾盂造影和逆行造影是诊断输尿管息肉常用的方法,术前确诊需输尿管镜活检。手术治疗以病灶局部切除为主。根据病变数量、累及输尿管范围及患者肾功能确定手术方案。     

腹腔镜联合输尿管镜肝内外胆管取石术（附34例报告）

目的总结腹腔镜联合输尿管镜治疗肝内外胆管结石的经验。方法34例慢性胆囊炎伴肝内外胆管结石患者,行LC术,术中应用输尿管镜对肝内外胆管结石进行取石、气压弹道碎石、高压冲洗等操作。结果全部患者手术均获成功,结石取尽率100%,术后1例出现拔除T管后胆漏,经T管窦道再放置引流等处理后治愈。结论腹腔镜联合输尿管镜气压弹道碎石术,有助于肝内外胆管结石的取尽并可减轻病人的身心痛苦。     

输尿管镜操作技巧及医源性损伤的临床分析(附372例报告)

目的:分析输尿管镜医原性损伤的原因、治疗和预防措施。方法:回顾两家医院自2007年1月～2009年8月所行的372例输尿管镜手术,男141例,女231例;年龄15～87岁,中位年龄42岁;输尿管镜结合钬激光碎石267例;输尿管镜检查术83例;输尿管镜下输尿管狭窄内切开术10例;输尿管镜下放置双J管9例;输尿管镜下拔出双J管3例。结果:发生输尿管损伤有18例(4.8%)。其中,输尿管口严重撕裂2例(11.1%),输尿管穿孔9例(50%),假道形成4例(22.2%),输尿管断裂2例(11.1%),输尿管全层撕脱1例(5.5%)。留置双J管保守治疗13例,开放手术5例。随访3个月～1年,2例轻度肾盂积水,其余病例恢复良好。结论:严格把握输尿管镜手术适应证,不断提高操作技巧可减少对输尿管医原性损伤,及时发现并妥善处理可明显改善患者预后。     

输尿管镜在580例输尿管疾病中的临床应用

目的　探讨输尿管镜处理输尿管疾病的临床价值。方法　回顾性分析 1997年 1月～ 2 0 0 4年 1月 5 80例输尿管结石、异物以及不明原因的血尿、肾积水采用输尿管镜诊治的临床资料。结果　输尿管镜用于诊断 79例 ,全部成功。治疗输尿管结石成功率为 92 .3 % ( 4 17/4 5 2 ) ,治疗输尿管狭窄 2 3例 ,取医源性输尿管双J管滞留 2 6例。其它疾病的疗效均满意。发生并发症 2 0例 ,占 3 .1%。结论　输尿管镜在输尿管疾病的诊治中具有重要临床应用价值。     

简化输尿管镜术治疗输尿管结石(附470例报告)

目的 探讨及总结简化输尿管镜术治疗输尿管结石的疗效及诊治经验。方法 在门诊内镜手术室骶管阻滞麻醉或尿道表面麻醉下行输尿管镜术加气压弹道碎石术治疗输尿管结石470例。结果 459例一次性碎石成功，成功率为97．7％。其中输尿管上段结石成功率为50％，中段98．0％，下段为100％。结论 简化输尿管镜术治疗输尿管结石创伤小、安全可靠，不须住院，医疗费用较低，对中下段结石成功率较高，可作为其内镜治疗的首选方法。     

输尿管镜气压弹道碎石术治疗尿道结石(附36例报道)

目的 总结输尿管镜气压弹道碎行术治疗男性尿道结石的疗效。方法 采用输尿管镜气压弹道碎石治疗男性尿道结石36例。结果 所有病例一次性碎石成功，平均碎石时间为17min。术后无明显出血、感染及尿道狭窄等并发症。随访3～7个月，均排尿通畅，无尿道狭窄及结石复发。结论 输尿管镜气压弹道碎石术治疗男性尿道结石，高效、安全，操作简单，值得推广。     

输尿管镜结合钬激光技术治疗孤立肾上尿路尿路上皮癌3例报告

目的总结输尿管镜结合钬激光技术治疗孤立肾上尿路尿路上皮癌的诊治体会。方法回顾性分析3例孤立肾上尿路尿路上皮癌患者的临床资料和随访结果。3例均为女性,1例输尿管癌,其对侧肾萎缩无功能;1例肾盂癌,曾因对侧输尿管癌接受肾输尿管全长切除术;1例为移植肾肾盂癌。3例患者均接受输尿管镜钬激光治疗。结果术后平均随访2年,3例患者均存活,其中1例无复发,1例因对侧萎缩肾一侧发生输尿管癌而再次接受输尿管镜钬激光治疗,术后无复发,1例因移植肾肾盂癌伴膀胱癌复发接受肾输尿管及膀胱切除术。结论对于解剖性或功能性孤立肾上尿路尿路上皮癌,输尿管镜结合钬激光技术是一种可选择方法,但术后应密切随访。     

mPCNL联合输尿管镜钬激光碎石术治疗复杂性同侧肾输尿管多部位结石(附73例报告)

目的:总结mPCNL联合输尿管镜钬激光碎石术治疗复杂性同侧肾输尿管多部位结石的方法、疗效及并发症,探讨临床应用价值。方法:回顾性分析mPCNL联合输尿管镜钬激光碎石术治疗73例复杂性同侧肾输尿管多部位结石患者的临床资料,男42例,女31例,年龄20～65岁,平均42岁,术前经B超、KUB与IVU、RUP或CT确诊。肾结石横径1.0～3.4cm,纵径1.8～4.2cm,输尿管结石横径0.5～1.2cm,纵径1.0～3.0cm,为同侧多部位存在,9例合并有对侧无积水肾结石。输尿管结石位于中下段的52例,上段的21例;并发肾积水73例,轻度47例,中度20例,重度6例。结果:73例手术均成功,患者全部治愈。所有的输尿管结石均一期取净。肾结石患者中一期取净结石59例,结石取净率达81%。9例残余<3mm位于肾盏内的小结石,未进行进一步处理。二期手术5例。术后发生全身炎症反应综合症3例,经抗感染对症药物治疗后治愈。肾周积液感染2例,B超定位下行穿刺引流后行细菌培养+药物敏感试验,选用敏感抗生素抗感染治疗痊愈。术中较大出血2例,输血并用气囊管压迫止血治愈。平均住院14d。无因并发症导致肾切除,无输尿管穿孔,无腹内脏器损伤,无中转开放手术,无死亡病例。结论:mPCNL联合输尿管镜钬激光碎石术治疗复杂性同侧肾输尿管多部位结石既逆行处理了输尿管结石,又确切地留置输尿管导管至肾盂,有利于人工肾积水形成经皮肾通道的建立,同时也减少了肾实质撕裂出血风险,显示出安全、创伤少、碎石清石率高、效果满意等优点     

输尿管镜气压弹道碎石术治疗输尿管结石(附364例报告)

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石的临床效果及并发症预防. 方法对364例输尿管结石患者采用输尿管镜气压弹道碎石术治疗. 结果输尿管镜直视下一次操作成功331例,成功率 90.9%,4～8周内结石全部排净.合并输尿管炎性息肉65例,均于术中用异物钳切除.发现输尿管移行细胞原位癌1例,行肾输尿管膀胱袖式切除术.发生并发症21例,其中输尿管穿孔12例,采取保守治疗7例,开放手术5例.随访1～21个月未发现输尿管狭窄.泌尿系感染9例,1例术后1月复查为左肾周脓肿行肾切除术. 结论输尿管镜气压弹道碎石治疗输尿管结石具有安全性高,并发症少,有效率高的优点,是治疗输尿管结石的有效方法之一.     

Combined electrohydraulic and holmium:YAG laser ureteroscopic nephrolithotripsy of large (greater than 4 cm) renal calculi

PURPOSE: Percutaneous nephrolithotripsy is standard treatment for renal calculi larger than 2 cm. Modern flexible ureteroscopes and accessories using the complimentary effects of electrohydraulic lithotripsy and holmium:YAG laser lithotrites can treat large (greater than 4 cm) branched renal calculi in a minimally invasive fashion with similar or superior results. This report is an assessment of the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of large (greater than 4 cm) branched renal calculi in the community setting. MATERIALS AND METHODS: A total of 16 patients with 17 branched renal calculi ranging from 41 to 97 mm (mean 65) in length and 560 to 2,425 mm2 (mean 1,169) in area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (body mass index greater than 30) was present in 81% and 38% were morbidly obese (body mass index greater than 40). An infectious etiology was present in 81% and hard stone components were present in 94%. All patients presented with hematuria, pain and/or recurrent urinary tract infection. Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly electrohydraulic lithotripsy. Laser drilling was used (in 4) to weaken hard stones before electrohydraulic lithotripsy. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. RESULTS: All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 15 of 17 renal units (88%) with a mean of 2.4 stages and 36 of 40 (90%) procedures performed on an outpatient basis. Operative time averaged 49 minutes per stage and 115 minutes per calculus. There were 3 patients admitted for fever and 1 patient (90 years old) admitted for pneumonia 3 days postoperatively. There were also 3 patients with calculi larger than 75 mm who required ureteroscopic management of steinstrasse. CONCLUSIONS: Staged ureteroscopic nephrolithotripsy of large renal calculi is feasible with low morbidity and stone clearance rates that compare favorably with percutaneous nephrolithotripsy.     

Treatment of ureteric lithiasis with retrograde ureteroscopy and holmium:YAG laser lithotripsy vs extracorporeal lithotripsy

OBJECTIVE

To analyse the efficiency of extracorporeal shockwave lithotripsy (ESWL) vs retrograde ureteroscopy and holmium:YAG laser lithotripsy, as ESWL is successful in 67–90% of cases but endoscopic lithotripsy with pneumatic lithotrites or lasers is successful in 90–96% of distal ureteric calculi, and holmium:YAG lithotripsy is effective in proximal ureteric calculi.

PATIENTS AND METHODS

From April 2006 to April 2008 we assessed 164 patients undergoing ureteric lithiasis in two homogeneous groups: group A included 83 treated with retrograde ureteroscopy and holmium:YAG endoscopic lithotripsy, and group B, 81 treated by ESWL. For laser lithotripsy we used 2071 mJ pulses at 3–6 Hz, with a mean of 1105 pulses and 2.5 kJ of total energy. ESWL was carried out using 37.5–87.5 mJ shock waves, a mean of 3650 shock waves and 187.6 J, with a radioscopy time of 1–4 min. The results were assessed after 3 weeks with plain films and ultrasonography, or urography. The efficiency of each procedure was assessed by calculating the relative risk, and results compared using the chi‐square or Student’s t‐test. The efficiency quotient (EQ) was determined for both procedures, and the focal applied energy quotient (FAEQ) used to assess ESWL.

RESULTS

The overall success rate for retrograde ureteroscopy and laser lithotripsy was 96.4% (80/83 patients), with an EQ of 0.52; a JJ catheter was placed in 67 patients. The success rate for the first ESWL session was 48%, and after repeat ESWL was 64% (52/81 patients), giving an EQ of 0.39. For successful treatments the FAEQ was 9.22, vs 6.47 for the failures (P < 0.005). There was a significant difference (P < 0.001) favouring laser lithotripsy, with an absolute benefit of 46% (95% confidence interval 33.8–57.9%), and number needed to treat of 2 (2–3), but no significant differences for lumbar ureteric calculi.

CONCLUSIONS

Endoscopic lithotripsy with the holmium laser is more effective than ESWL, but for lumbar ureteric calculi ESWL is therapeutically recommended as it is less invasive.