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。

To analysis of etiology,treatment and prevention of iatrogenic ureteroscopic injury(report of 372 cases)

Objective:To investigate the cause of iatrogenic injury of ureter,and improve the procedures of treatment or prevention.Method:The operational data were retrospective analized in 372 patients with ureteroscope,including 267cases of transureteroscope holmium laser,83 cases of ureteroscopy,10 cases of endoscopic incision for ureteral stricture,9 cases of placing double J ureteral stents and 3 case of extraction of double J ureteral stents.Result:Eighteen(4.8%)cases of ureteric injury were happened including 2(11.1%)cases of ureteric orifice evulsion,9(50%)cases of ureterodialysis,4(22.2%)cases of false passage formation,2(11.1%)case of ureteric tear and 1(5.5%)case of avulsed ureter injury.Twenty-five patients received expectant treatment with indwelling double-J tube,and 5 patients had undergone open operation.During 3 to 12 months follow-up,2 cases only exhibited mild hydronephrosis,while the others recovered perfectly.Conclusion:We concluded that three key factors could help to avoiding iatrogenic injury:following the surgical indication strictly,improving the operation skill and conversion to open operation necessarily.