应用输尿管镜治疗输尿管梗阻124例

报告我院应用输尿管镜治疗输尿管梗阻性病变 1 2 4例。1　资料与方法1 .1　临床资料本组 1 2 4例 ,男 6 8例 ,女 5 6例 ;年龄 1 8～ 6 9岁 ,平均 3 5 .4岁。输尿管梗阻原因 :结石 1 0 9例 ,输尿管异物 3例 ,血凝块 4例 ,单纯炎症息肉 8例。结石 1 0 9例中 ,阳性结石 84例 ,阴性结石 2 5例 ,结石并发炎性息肉 1 2例 ,上段结石 1 5例 ,中段结石 3 8例 ,下段结石 5 6例 ;单枚结石 86例 ,多发结石 2 3例 ;其中 6例系体外冲击波碎石术 (ＥＳＷＬ)治疗后输尿管“石街” ,均位于输尿管中下段。结石大小(0 .2～ 1 .5 )ｃｍ× (0 .2～ 1 .8)ｃｍ。输…     

输尿管电切镜在网状金属支架内纤维增生性狭窄治疗中的应用

目的 探讨输尿管电切镜治疗金属网状支架内纤维增生性狭窄的临床价值.方法 回顾性分析2005年10月至2006年12月7例采用Storz输尿管电切镜治疗输尿管网状金属支架内纤维增生性狭窄的患者资料.男5例,女2例,平均年龄46岁.合并同侧肾结石3例,合并同侧肾积脓1例.7例中顺行经皮肾通道处理6例,逆行经尿道处理1例;一期处理5例,二期处理2例.术后输尿管内留置单J或双J管,2～6个月换管1次.术后定期B超、IVU或输尿管镜复查.结果 7例患者上尿路梗阻解除,随访3～32个月,效果满意,未出现大出血、输尿管穿孔、金属支架断裂、脓毒血症等并发症.结论 输尿管电切镜治疗网状金属支架内纤维增生狭窄具有创伤小,恢复快、可重复治疗等优点,是一项安全、有效的腔内新技术.     

移植肾并发输尿管梗阻的治疗

目的 探讨肾移植术后并发输尿管梗阻的治疗策略.方法 同种异体肾移植术后7 d～10年并发输尿管梗阻患者34例,其中3例移植输尿管部分坏死患者以开放手术治疗,其余31例采用经尿道逆行输尿管镜技术及经皮肾穿刺顺行输尿管镜技术进行碎石、内切开或扩张等方法解除梗阻,放置双J管内引流,观察患者肾功能改善情况.结果 3例开放手术清除坏死段输尿管后移植输尿管再吻合成功;1例输尿管内血凝块堵塞者成功清除血凝块;2例输尿管膀胱吻合口水肿、11例输尿管膀胱吻合口狭窄及6例吻合口上方狭窄患者行狭窄段扩张或内切开;6例输尿管结石及1例体外冲击波碎石术后石街患者行输尿管镜碎石、取石治疗;2例输尿管迂曲及2例尿漏患者行输尿管镜下置管术.术后随访18～50个月,29例引流通畅,肾功能恢复正常,血肌酐45～120μmol/L;5例肾功能恢复较差,血肌酐170～360 μmol/L;1例吻合口上方狭窄患者需定期更换支架管.结论微创技术治疗移植肾输尿管梗阻疗效好、安全.     

输尿管镜在输尿管梗阻中的诊治价值

目的探讨输尿管镜在输尿管梗阻诊治中的价值.方法应用输尿管镜对52例非结石性输尿管梗阻进行诊治.结果输尿管狭窄35例(行输尿管镜硬性扩张19例,气囊扩张13例,腹腔镜下输尿管成形术3例),输尿管息肉13例行钬激光切除,输尿管癌3例改行开放手术,腔静脉后输尿管1例改行输尿管成形术.手术并发黏膜明显裂伤或黏膜下假道2例,输尿管穿孔1例,其它并发症.结论输尿管镜术能明确输尿管梗阻的病因,并能采取相应治疗.     

输尿管镜治疗急性输尿管梗阻

目的探讨输尿管镜在急性输尿管梗阻的诊断及处理中的优势。方法回顾分析54例急性输尿管梗阻经过输尿管镜技术治疗的临床资料。结果52例经过输尿管镜技术成功解除梗阻。结石性梗阻50例,其中双侧输尿管结石3例,孤肾1例;息肉及狭窄各1例。2例因置镜失败经过手术解除梗阻,术后证实为结石。结论输尿管镜技术对急性输尿管梗阻性疾病具有诊断及治疗双重作用,对于持续性肾绞痛及急性肾后性肾功能不全等需急诊处理者更为适宜。     

输尿管镜钬激光治疗输尿管结石并息肉增生的临床疗效分析

目的 探讨经输尿管镜钬激光治疗输尿管结石并息肉增生的临床疗效.方法 回顾性分析38例采用输尿管镜钬激光治疗输尿管结石并息肉增生患者的临床资料.结果 一次性息肉切除并碎石成功31例;4例息肉切除时结石上移至肾盂内,术后1周行体外冲击波碎石治疗,效果良好;2例输尿管穿孔,留置双J管2个月后,二期输尿管镜手术成功.1例输尿管癌改开放手术治疗.37例随访半年,复查KUB+IVP显示输尿管通畅,未见明显结石残留.结论 输尿管镜钬激光治疗输尿管结石并息肉增生是一种安全、有效的治疗方法,具有创伤小、疗效好、并发症少等优点,值得临床推广.     

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.     

经尿道输尿管肾镜的临床应用

我院自 1990年～ 2 0 0 0年 4月应用经尿道输尿管肾镜技术治疗输尿管结石32 6例 ,取得了较好的效果 ,报告如下。一、临床资料和方法1.本组 32 6例 ,男 12 9例 ,女 197例 ;年龄 2 0～ 70岁。其中 9例为双侧输尿管结石 ,同时治疗 7例 ,分次治疗 2例 ,共治疗 32 8例次 ,335例侧。输尿管上段结石 2 7例侧 ,中段结石 78例侧 ,下段结石 2 30例侧。输尿管结石梗阻并发肾积脓 3例。术中发现有输尿管息肉 2 3例。2 0 3例次采用持续硬膜外麻醉 ,12 5例次采用神经安定镇痛术和尿道粘膜表面麻醉或 2种方法同时应用。2 .手术采用ＷＯＬＦＦ9 5～ 11 5输尿…     

低压输尿管镜治疗合并感染的急性输尿管梗阻

目的 探讨术中低压技术治疗输尿管结石梗阻合并严重感染的可行性.方法 对28例输尿管结石合并急性感染的患者一期行输尿管镜下置入F5双J管引流;二期采用术中保留F5双J管、留置F8尿管、低灌注水压等低压技术以小口径输尿管镜行钬激光碎石术.结果 28例一期均行输尿管镜留置双J管引流成功.二期采用输尿管镜下钬激光碎石术,23例术中保留双J管,5例术中未保留双J管.2组中均有2例出现术后发热;分别有0例、1例出现结石退回肾内.所有病例于术后3个月复查无结石残留,患者肾功能不同程度恢复.结论 一期采用输尿管镜下留置F5双J管,二期采用术中低压技术并以小口径输尿管镜行钬激光碎石术解除梗阻是治疗合并感染的急性输尿管梗阻的有效治疗手段.     

后腹腔镜联合尿道电切镜根治性肾输尿管切除治疗上尿路移行细胞癌(附16例报告)

目的 探讨后腹腔镜联合尿道电切镜根治性肾输尿管切除治疗上尿路移行细胞癌的方法和临床疗效. 方法 对10例肾盂癌、6例输尿管上中段移行细胞癌先采用尿道电切镜行患侧输尿管口膀胱黏膜袖套状切除,而后行后腹腔镜根治性肾输尿管全切术. 结果 16例手术均获成功,平均手术时间120 min,术中出血平均80 ml,患者均于术后36～48 h下床活动,术后住院时间8～14 d(平均9.4 d),术后随访膀胱局部复发2例. 结论 后腹腔镜联合尿道电切镜根治性肾输尿管切除治疗上尿路肿瘤是一种安全、有效的微创手术方法,实用性较强,具有良好的应用前景.     

Ureteroscopic management of transitional cell carcinoma of the ureter using the neodymium:YAG laser

Ureteroscopy offers an extension of endoscopic diagnosis and treatment to upper urinary tract malignancy. Combination of ureteroscopy and the Nd:YAG laser permits accurate and effective treatment of ureteral neoplasms. Nine highly selected patients, six males and three females, were treated with low grade papillary transitional cell carcinomas of the ureter with at least 24 months follow-up. Follow-up cytology and IVP have indicated no evidence for disease recurrence between the follow-up periods and minimal morbidity to the ureteroscopy and laser treatment. © 1993 Wiley-Liss, Inc.     

输尿管镜致输尿管严重损伤的处理

目的探讨输尿管镜致输尿管严重损伤的处理方法。方法回顾性分析我院2 876例输尿管镜诊疗过程中15例输尿管严重损伤的临床资料。15例中,输尿管断裂4例,均行输尿管吻合术;输尿管全层撕脱4例,其中1例行肾下移输尿管膀胱瓣吻合,2例行回肠代输尿管术,1例行肾切除术;输尿管黏膜袖套样剥离7例,其中4例内置双J管引流,1例行输尿管膀胱瓣吻合,2例行回肠代输尿管术。结果所有患者均经随访3个月～3年,1例出现输尿管末端狭窄闭锁,行输尿管膀胱再植术后治愈,1例因反复肾感染行肾切除外,余13例均无异常。结论输尿管镜手术致输尿管严重损伤时,及时发现损伤并按损伤类型不同,分别采用输尿管吻合、输尿管膀胱吻合、回肠代输尿管等方法处理,疗效满意,预后好。     

各类输尿管瘘原因及预后分析

目的对输尿管瘘患者临床资料及不同处理方式疗效进行回顾分析，总结临床诊治经验。 方法我科自2013年5月至2018年5月共收治19例各类原因所导致的输尿管瘘患者，其中男性4例，女性15例，平均年龄为（51±13）岁。19例患者中，17例患者首先进行输尿管镜检+输尿管支架管（双J管）置入术，如输尿管镜检失败，则视情况改行肾造瘘术或输尿管膀胱再植术；2例因感染较重，且腹膜后尿囊明显，遂行尿囊穿刺引流术+患肾造瘘术。 结果8例患者成功行输尿管镜检+双J管置入术，5例最终恢复正常；9例逆行输尿管镜检失败的患者，3例直接同期行输尿管膀胱再植术；6例改行肾造瘘术，其中3例因后期瘘口未愈，半年后行输尿管膀胱再植术。3例患者因反复感染，最终切除患肾。 结论如果Ⅰ期输尿管镜检查术可恢复输尿管连续性，可尝试留置双J管；如Ⅰ期输尿管镜检查术失败，患者条件允许情况下，则应选择同期行输尿管修补术或输尿管膀胱再植术，单纯行肾造瘘术只会延长病程并不能改变患者最终结局；感染是导致输尿管瘘患者最终切肾的主要因素。     

经尿道输尿管镜联合体外震波碎石治疗输尿管结石256报告

目的探讨输尿管镜联合体外震波碎石（extracorporeal shock wave lithotripsy，ESWL）治疗输尿管结石的价值。方法2005年10月-2007年6月采用输尿管镜联合ESWL治疗输尿管结石256例，中段（56例）及下段（170例）结石用输尿管镜取石，上段（30例）结石用ESWL碎石，输尿管镜取石失败或结石残留联合ESWL治疗。结果输尿管下段结石一期结石清除率98．2％（167／170），中段结石一期结石清除率89．2％（50／56），上段结石一期结石清除率73．3％（22／30）。输尿管穿孔3例，输尿管黏膜撕脱1例，结石远端输尿管扭曲进镜致使尿管穿孔改切开取石1例，输尿管镜取石失败或结石残留联合ESWL治疗二期结石清除率91．7％（11／12）。结论输尿管镜治疗输尿管下段及中段结石成功率高，输尿管镜取石失败或结石残留联合ESWL可提高二期结石清除率。     

输尿管镜诊治输尿管疾病92例体会

目的 探讨提高输尿管镜诊治输尿管疾病水平的方法。方法回顾分析92例输尿管疾病经输尿管镜诊治的临床资料。结果输尿管镜检与手术治疗成功率92．4％(85／92)。手术并发假道形成2例，无1例严重并发症。结论在输尿管导管或导丝引导下，采用手控间断灌注扩张法直接或旋转上挑进镜，安全可靠，手术成功率高。利用输尿管导管或套石篮固定结石及间断低流灌注可提高碎石率。     

Ureteroscopic treatment of multiple distal-ureteral stones

BACKGROUND AND PURPOSE: Ureteroscopic intracorporeal lithotripsy for solitary distal-ureteral stones may be considered a first-line therapy. However, few reports that mention ureteroscopic procedures for multiple ureteral stones were found in the literature. Retrospectively, we reviewed our patients who were treated by ureteroscopy for multiple distal-ureteral stones. PATIENTS AND METHODS: Fifteen patients underwent ureteroscopic pneumatic lithotripsy for unilateral multiple distal-ureteral stones. Ten patients had two stones, four patients had three stones, and another patient had five stones. The average stone number per ureteral unit was 2.44, and the average stone size was 9.7 mm (range 3-23 mm). RESULTS: Eighty percent of the patients (12/15) who had unilateral stones were stone free after the first session of ureteroscopic pneumatic lithotripsy. Two patients underwent a second ureteroscopy procedure for the remaining stone or failure of ureteral access. Overall, 93.3% of the patients (14/15) were stone free. Ureteral perforation as a major complication occurred in one patient (6.6%), who was treated by open surgery. We did not routinely use Double-J ureteral stents after ureteroscopy. Only one patient required stenting because of failure of ureteral access. Steinstrasse was observed in three patients, but it resolved spontaneously in the early postoperative period. CONCLUSION: Ureteroscopic pneumatic lithotripsy has a high success rate with few complications for the treatment of unilateral multiple distal-ureteral stones. Ureteroscopic pneumatic lithotripsy seems very effective for such stones.     

Current therapy of ureteral calculus

Since lithotripsy requiring no anesthesia recently became available, the discussion revolving around the treatment of choice for ureteral calculi has been renewed: is a preliminary retrograde manipulation still preferable for proximal calculi? Is ureteroscopy the better treatment for stones in the lower ureter? The retrospective evaluation of our patients with ureteral calculi (January to August 1988) failed to reveal a compromised efficiency with the modified HM3 Lithotripter (40 nF generator, 17 cm ellipsoid): 70% (including 11% with repeated sessions) of patients with proximal stones and 90% (including 28% with repeated sessions) of patients with distal calculi were successfully treated by in situ ESWL with no need for anesthesia, auxiliary measures, or ureteroscopy. These results do not significantly differ from those obtained with the old HM3, and they confirm that the majority of patients with ureteral calculi can bypass the discomfort of retrograde manipulation and the risks of ureteroscopy.     

输尿管镜在早期泌尿系结核诊治中的应用

目的:探讨输尿管镜在早期泌尿系结核诊断和治疗的应用价值。方法:回顾性分析21例应用输尿管镜诊断和治疗早期泌尿系结核患者的临床资料。21例输尿管镜表现分别为输尿管狭窄14例、输尿管开口炎性水肿4例、输尿管下段息肉3例。18例通过输尿管镜收集肾盂尿作结核杆菌聚合酶链反应(MTb-PCR)、沉渣找抗酸杆菌(AFB)检查和结核杆菌培养诊断为泌尿系结核,其中16例(88.9%)尿MTb-PCR呈阳性,11例(61.1%)尿沉渣找AFB阳性,7例(38.9%)结核杆菌培养阳性。3例输尿管下段息肉,用输尿管镜摘除息肉作病理检查,2例病理诊断为输尿管结核,1例误诊为输尿管炎性息肉。11例输尿管下段狭窄予行输尿管镜狭窄内切开术,其余10例予行输尿管镜扩张置管术。除误诊为输尿管炎性息肉的1例患者外,20例术后均予抗结核治疗至少6个月。结果:21例平均随访18个月,12例(57.1%)一次手术治愈;8例出现狭窄复发,5例需再次行输尿管镜狭窄内切开术治愈,3例因狭窄多次复发致无功能肾行患肾切除术;误诊为输尿管炎性息肉1例,术后12个月复查发现患侧结核性脓肾及膀胱挛缩,予行患肾切除+乙状结肠膀胱扩大术。结论:早期泌尿系结核可表现为输尿管狭窄、输尿管开口炎性水肿或输尿管下段息肉。输尿管镜技术有助于早期诊断和治疗泌尿系结核。     

Frequent Recurrence of Superficial Bladder Tumors in the Periorificial Region: Possible Predictor for Delayed Appearance of Invasive Intramural Ureteric Cancer

Two cases of invasive lower ureteric cancer developed following frequent recurrence of superficial bladder tumors in the region of the ureteral orifice. The cancer focus could not be identified in the intramural ureter prior to intravenous urography which revealed hydronephrosis. When bladder tumors repeatedly develop near the ureteric orifice, careful investigations such as ureteral catheterization with a small brush for cytology or ureteroscopy are necessary for the early detection of invasive disease.
bladder neoplasms,
ureteral neoplasms     

Comparison of transurethral ureteroscopy and extracorporeal shock wave lithotripsy for treatment of ureteral calculi

Ureteral calculi were treated by transurethral uretereoscopy and extracorporeal shock wave lithotripsy (ESWL), and the results were compared. Rigid transurethral ureteroscopy was performed in 50 patients, and 10 of 22 stones located in the upper ureter and 25 of 29 stones located in the lower ureter were successfully extracted. On the other hand, we treated 88 patients with upper ureteral stones by ESWL and achieved a success rate of 89.8%. We therefore conclude that for upper ureteral stones, ESWL is the more effective treatment and, for lower ureteral stones, transurethral ureteroscopy.