输尿管镜腔内治疗输尿管狭窄的临床分析

目的探讨输尿管镜腔内治疗输尿管狭窄的临床疗效。方法回顾性分析2008年12月～2010年12月输尿管狭窄89例的临床资料,其中肾盂输尿管连接部狭窄7例,输尿管上段狭窄38例、中段狭窄16例、下段狭窄28例。狭窄段长度0.5～1.5 cm。采用腔内输尿管扩张治疗29例,自制单极电刀内切开治疗7例,钬激光内切开治疗53例。术后留置1根或2根F6输尿管内支架管,3～6个月后拔除。结果手术时间5～40 min,平均16.5 min。2例因并发输尿管穿孔中转开放手术,其余无严重并发症发生。术后随访6～12个月,平均8.9月。81例(91.0%)临床治愈,术后经超声、静脉肾盂造影等影像学检查显示肾盂积水明显好转,输尿管扩张减轻,狭窄段消失或较治疗前增宽;8例(9.0%)狭窄复发,再次行腔内治疗治愈。结论输尿管镜腔内治疗输尿管狭窄具有创伤小、手术时间短、并发症少、恢复快等优点,是一种安全、有效的微创治疗方法。

Minimally Invasive Ureteroscopic Treatment for Ureteral Stenosis

Objective To investigate the efficacy of ureteroscopy for the treatment of ureteral stenosis.Methods Clinical data of 89 patients with ureteral stenosis,who received treatment in our hospital from December 2008 to December 2010,were analyzed retrospectively.Among the cases,7 had the stenosis at the pyeloureteral junction,38 at the upper ureter,16 at the middle ureter,and 28 at the lower ureter.The length of the ureteral stenosis ranged from 0.5 to 1.5 cm.We performed endoscopic ureteral dilation on 29 of the patients,endoscopic incision with monopolar electrotome on 7 patients,endoscopic incision with Ho:YAG laser on the other 53 patients.One or two F6 Double-J stent was placed after the operation and then was removed at 3-6 months postoperation.ResultsThe operation time ranged from 5 to 40 min with a mean of 16.5 min.Two of them were converted to an open surgery because of ureteral perforation.No other severe complications occurred during and after the whole procedure.The patients were followed up for 6 to 12 months with a mean of 8.9 months,during which,81 cases(91.0%) were clinically cured with ultrasonography and intravenous pyelography showing that the hydronephrosis was improved,the dilated ureter was reduced,and the stenostic segment disappeared or was dilated;the other 8 patients(9.0%) had recurrent stenosis,and then was cured by a second ureteroscopic intervention.Conclusions Ureteroscopic therapy is safe,effective and minimally invasive for ureteral stenosis with short operation time,lower complication rate and fast recovery,and therefore is worth being widely used.