钬激光内切开术治疗输尿管狭窄的临床分析

目的探讨输尿管镜下钬激光内切开加留置7-12F外套式双J管治疗输尿管狭窄的效果。方法2001年3月-2004年10月采用经输尿管镜钬激光内切开治疗56例62次输尿管狭窄，术中留置7-12F外套式双J管，术后2、3个月拔除双J管，拔管后4周、12周、0．5a进行超声、排泄性尿路造影及肾图检查。结果术后56例共随访了50例，随访率89．2％，随访3-40个月；42例／50例治愈（治愈率84．0％），36例／50例一次内切开治愈（1次切开治愈率72．0％），6例／50例行2次以上内切开治愈（占12．0％）。IVP检查提示：输尿管狭窄段消失。B超示：肾孟集合系统分离从术前平均31mm缩小到术后平均16mm（P〈0．01）。2例因肾脏无功能伴感染行肾切除术；1例术后出现大出血；1例行输尿管膀胱移植。结论输尿管镜下钬激光内切开加留置7-12F外套式双J管治疗原发性和继发性输尿管狭窄具有创伤小，疗效较佳的优点。

Clinical analysis of inside incision with Holmium: YAG laser for managing ureteral struture

objective To evaluate the effectiveness of ureteroscopic holmium: YAG laser setting thick cradle for managing ureteral stricture. Methods] Inside incision with ureteroscopic holmium: YAG laser setting 7~12 F pipe with outer, type double J. Using such way in 56 ureteral stricture patients from Mar. 2001 to Oct.2004. Pull out the pipe after two or three month, take ultrasonic wave and IVP after 4 weeks, 12 weeks and 6 monthes. Result] The 50 patients out of 56 had been followed-up from 3 monthes to 40 monthes after operation, rate of followed-up is 89.2%; 42 cases with satisfactory results, the cure rat is 84.0%, 36 patients were cured in first incision (first incision cure rate is 72.0%). 6 had secondary inside incision before curing. Taking IVP, ureteral stricture were disappeared. Taking ultrasonic wave, the separation of collecting system is from 31 mm before operation to 16 mm after operation (P <0.01). 1 case was taken ureterocystostomy. 2 cases were taken nephrectomy since the kidney has nofunction since infection. 1 case was hemorrhage after operation. Conclusion] It is effective and safe to manage ureteral stricture primary or subsequently taking by ureteroscopic holmium:YAG laser setting thick cradle.