硬性输尿管镜入镜困难的探讨

目的：探讨硬性输尿管镜手术时入镜困难的原因与处理方法。方法：回顾性分析广西医科大学第九附属医院泌尿外科2003年1月-2011年1月实施输尿管镜手术345例次的临床资料，其中44例发生入镜困难，均采用相关方法成功处理，总结入境困难的原因及处理经验。结果：17例采用技巧性旋转入镜成功，16例采用调节体位输尿管扩张等方法入镜成功，2例行输尿管末端汽化电切术，4例行输尿管狭窄段切开术，2例中转开放手术，5例插管后行体外冲击波碎石术（ESWL）。结论：熟悉输尿管的解剖与病理生理特点，以及手术者的优良操作技巧经验是入镜成功的关键。

Discussion of diffcult access during rigid ureteroscopy

Objective：To investigate the causes and solutions of difficulty passing instrument during rigid transurethral ureteroscopy. Methods： We retrospective analyzed the data of 345 patients who underwent rigid ureteroscopic lithotripsy in Department of Urology, Ninth Affiliated Hospital of Guangxi Medical University between January 2003 to January 2011. These data included 44 cases of difficulty passing instruments which were managed successfully with proper strategies. The causes and experiences with the management in these cases were summarized. Results ： Among 44 cases, the instruments were successfully passed into the urinary tract with rotation techniques in 17 patients, modification of patient position plus fascial dilation of ureter in 16, vaporization and resection of distal ureter in 2, and incision of ureteral stricture in 4. Two cases were converted to open surgery, and 5 to ESWL with indwelling of ureter catheter. Conclusion： Good knowledge of ureteral anatomy and pathophysiology, excellent manipulation skills, and experiences of the surgeon are critical to successful passing of instruments during ureteroseopy.