输尿管镜下钬激光治疗输尿管结石致输尿管损伤原因及防治（附23例报告）

目的 探讨输尿管镜下钬激光治疗输尿管结石致输尿管损伤发生的原因和防治措施。方法 对656例输尿管镜下钬激光治疗输尿管结石术中发生的23例输尿管损伤进行了回顾性研究。结果 本组23例，输尿管穿孔20例，其中2例改开放手术；输尿管黏膜下假道1例；输尿管黏膜撕脱2例，均改开放手术。结论 钬激光不是绝对安全的，在治疗输尿管结石术中正确使用钬激光及输尿管镜能避免大多数输尿管损伤。     

输尿管镜下气压弹道碎石术并发症分析

目的探讨输尿管镜下气压弹道碎石术并发症产生的原因和防治措施。方法对600例输尿管镜下气压弹道碎石术发生的并发症进行回顾性分析。结果600例手术共发生并发症162例：输尿管穿孔12例（2％）;输尿管口撕裂假道形成8例（1．3％）;术后输尿管狭窄行肾切除1例（0．17％）;结石返回肾脏24例（4％）;肉眼血尿21例（3．5％）;术后尿路感染15例（2．5％）;肾绞痛16例（2．7％）;结石残留41例（6．8％）;置镜失败18例（3％）。结论熟练输尿管镜操作技术是减少其并发症的关键,严格掌握适应证可预防严重并发症发生。     

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.     

等离子输尿管口切开术辅助输尿管镜治疗输尿管下段结石

目的:探讨等离子输尿管口切开术辅助输尿管镜治疗输尿管下段结石的应用价值。方法:回顾性分析我院2015年6月～2018年6月"一步法"进镜失败的17例患者临床资料。以等离子电切切开输尿管口,小的结石整体钩出,较大结石以输尿管镜镜身推入输尿管,行钬激光碎石。2例无法确定患侧输尿管口位置,在健侧输尿管口的对称位置,薄层电切膀胱黏膜及浅肌层,找到输尿管口,继以输尿管镜钬激光碎石。结果:17例均1次手术成功。13例患者获随访,随访6～24个月,平均12个月。术后6个月复查彩超见肾积水消失,无结石残留,无输尿管口狭窄的表现。10例行膀胱尿道造影,无膀胱输尿管反流。结论:等离子输尿管口切开术,操作简单,安全有效,并发症少,提高了输尿管镜手术成功率,使很多患者避免了开放手术,建议作为输尿管镜碎石术的辅助手段,广泛应用于临床。等离子电切具备一定的自身优势。术中切开不超过6 mm,反流发生的可能性小。     

输尿管镜下钬激光碎石治疗输尿管膀胱壁段结石

目的：探讨不切开输尿管口,直接输尿管镜下钬激光碎石治疗输尿管膀胱壁段结石的手术技巧。方法：选取输尿管膀胱壁段结石患者32例,根据结石的分类,不切开输尿管口,采取盲法结合直视下输尿管镜钬激光碎石,术后留置双J管2～4周,3～6个月后复查B超、CT或者IVU。结果：32例患者均成功粉碎结石,其中10例发生输尿管黏膜轻微撕脱,1例发生输尿管黏膜下假道。留置双J管后随访,复查正常。结论：不切开输尿管口,采取盲法结合直视下输尿管镜钬激光碎石治疗输尿管膀胱壁段结石是一种安全有效的微创治疗。     

输尿管镜碎石术并发输尿管损伤临床分析

目的总结输尿管镜碎石术并发输尿管损伤及其防治措施。方法对150例应用输尿管镜碎石术患者临床资料进行回顾性分析,统计术中、术后输尿管损伤发生情况及其处理方法。结果发生输尿管损伤7例,均术中发现,其中输尿管穿孔5例。均成功留置双J管;l例术中输尿管下段完全断裂改开放手术行输尿管膀胱再植术治愈;1例术中发现下段粘膜撕脱约lcm,经抗感染、留置双J管2个月等治疗后恢复。结论应用输尿管镜手术成功率高。输尿管损伤较少见.且绝大多数行保守治疗可得到解决;熟练的手术操作是减少输尿管损伤的关键。     

半硬质输尿管镜操作引起输尿管或肾实质穿通损伤的分析

目的提高对半硬质输尿管镜操作中的穿通性损伤发生的认识及预防能力。方法回顾性分析2004年9月至2008年10月间我科收治的半硬质输尿管镜操作所致泌尿系统损伤11例,其中输尿管穿孔4例,输尿管假道2例,结石穿出输尿管3例,肾实质穿通性损伤2例。结果输尿管损伤者中6例接受手术修补输尿管并留置双J管,3例输尿管假道或结石穿出者在输尿管镜下放置双J管。术后三至四周拔除双J管,均恢复良好。对肾实质穿孔者,1例采用手术引流,1例证实为肾结核而行患’肾切除并抗结核治疗而治愈。结论输尿管或肾实质穿孔是半硬质输尿管镜操作中的较重并发症。正确的病例选择、良好的手术视野和尽可能低的灌注压力有利于避免这些并发症的发生。     

输尿管镜在尿道狭窄和尿道假道诊治中的应用(附15例报告)

目的探讨输尿管镜在尿道狭窄和尿道假道诊断和治疗中的应用价值。方法应用输尿管镜技术诊断及协助治疗尿道狭窄及尿道假道15例，其中前列腺切除术后尿道内口狭窄5例，外伤后尿道狭窄4例，尿道假道6例。结果15例患者均在术中得以确诊，并同时在良视下将输尿管镜或导丝插过狭窄段或进入尿道真道，进一步完成尿道内切开术或电切术。手术时间15—60min，平均30min。术后2—4周拔除导尿管，均排尿通畅。结论在尿道狭窄或假道的处理中，输尿管镜的应用可增加诊断和治疗的准确性和成功率，降低手术难度。减少手术创伤。     

输尿管镜治疗输尿管结石致输尿管损伤的防治体会(附15例报告)

目的分析及探讨输尿管镜治疗输尿管结石致输尿管损伤的原因和防治措施。方法 2007-07—2012-07,对510例输尿管结石采用输尿管镜行气压弹道和超声碎石,其中15例发生输尿管损伤。对损伤的原因及防治措施进行分析。结果 15例并发症(2.9%)中,输尿管穿孔12例(2.3%),其中输尿管中段结石8例,下段及末端结石4例,10例术中立即留置双J管成功,2例改为腹腔镜下输尿管切开取石。输尿管黏膜下假道1例(0.1%),术中留置双J管成功。输尿管黏膜不完全撕脱2例(0.3%),因撕脱长度较短,改为开放手术处理。结论输尿管镜手术为常见的泌尿外科手术,安全性相对较高,但术中可变性较大,正确操作手法及丰富经验,对避免输尿管损伤极为重要。     

输尿管镜技术与并发症的防治(附2 280例报告)

目的 探讨输尿管镜进镜技巧,分析输尿管镜手术并发症发生的原因及其预防方法.方法 对1988年1月至2007年10月所做的2 280例输尿管镜技术治疗输尿管疾病所发生的并发症进行回顾性分析.结果 术中输尿管黏膜撕脱3例,输尿管穿孔18例,输尿管黏膜下假道17例,输尿管损伤致中转开放手术23例,大出血3例,严重泌尿系感染17例,其中感染性休克2例,术后肾绞痛发作19例,随访3个月～16年,输尿管狭窄15例.结论 熟练的输尿管镜技术、手术适应证的严格掌握以及输尿管镜下输尿管异常情况的识别是减少输尿管镜技术并发症的关键.     

经膀胱镜逆行输尿管插管困难的对策(附80例报告)

目的对膀胱镜下输尿管导管逆行插管困难的病例进行总结。方法从1993年9月至2005年6月期间,应用22FrStorz膀胱镜逆行插管行逆行肾盂造影,引流或灌药共1280例。共遇到插管困难病例80例:其中输尿管口狭小10例,向内侧开口20例,壁内段狭窄20例,中上段“Z”型成角20例,息肉包裹结石10例。结果80例插管困难病例成功60例。成功率75%。20例插管失败者改行输尿管镜插或MRU(磁共振尿路水成像)。术中出现并发症20例。10例为小的穿孔。10例为粘膜撕裂出血。结论泌外医生应熟识输尿管解剖生理和病理。应对膀胱镜进行插管成功的关键在于手术者的操作技巧与经验。     

输尿管镜术中输尿管口丢失的应对策略

目的探讨输尿管镜术中输尿管口丢失的应对方法。方法报告输尿管镜术中因输尿管口丢失而进镜失败的14例患者的处理过程及结果。先采用斜仰卧截石位,实时超声定位下以G18穿刺针朝向肾盂输尿管连接部穿刺患肾中上盏,从针芯中顺行向输尿管内推置亲水导丝,如可见导丝进入膀胱,则沿导丝径路进镜;如导丝无法顺行进入膀胱,则换用经尿道电切镜,薄层电切患侧输尿管口对应部位,显露输尿管壁内段断端,置入亲水导丝后换用输尿管镜进镜。所有患者术后均留置F7双J管1~2根。结果11例肾穿刺顺行置入导丝可见进入膀胱,沿导丝成功进镜入输尿管;3例此法失败者采用输尿管口部位电切法成功进镜。所有患者肾穿刺针和导丝拔除后无大出血,无输尿管穿孔、撕脱等严重并发症,术后2~3个月拔除双J管后未发生输尿管口狭窄。结论输尿管镜术中发生输尿管口丢失,依次采用肾穿刺顺行导丝置入法和输尿管口部位电切法寻找输尿管口成功率高,创伤小,无严重并发症发生。     

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。     

Ureteroscopic injuries to the upper urinary tract

Kaufman reported a severe ureteral injury following ureteroscopy in 1984. His commentary summarizes the important messages in this article well: The intent of this report is not to denegrate the splendid advances in nephroscopy and ureteroscopy, but rather to introduce a sobering message that the patient must be informed of the inherent risk of such procedures and that the urologist must be wary of the problems that might occur. Problems have been known ever since endoscopic instrumentation was first introduced, and every experienced urologist has had his share of problems associated with stone extraction and other endoscopic procedures. Traditional teaching in urology has been to eschew manipulation of stones in the upper two thirds of the ureter because the lumbar ureter is mobile and more easily damaged by instrumentation than the pelvic segment. Endoscopic visualization of stones in the upper ureter allowing accurate grasping of calculi would appear at first to provide an element of security heretofore unachievable, but urologists nonetheless should be mindful of the hazards of any type of stone extraction from the upper ureter. Urologists must be ready and equipped to handle emergencies associated with new instruments and techniques, and the patients must be apprised of the exigencies. "Caveat emptor" (buyer beware) could not be a more apt or timely maxim in our specialty. Ureteroscopy has greatly aided many patients, and a large number of urologists have integrated this procedure into their daily practices.(ABSTRACT TRUNCATED AT 250 WORDS)     

输尿管镜术中困难和并发症的原因与对策

目的：探讨输尿管镜术中困难和并发症的原因及应对策略。方法：回顾性分析1998年3月-2008年10月行输尿管镜手术的900例患者临床资料。结果：900例患者中．术中困难83例,其中45例为早期病例;中转开放手术24例,其中14例为早期病例。24例中转开放手术的原因为：未找到输尿管3例（12．5％）,入镜失败5例（20．9％）,上镜困难（未达到病变部位）5例（20．9％）,输尿管穿破7例（29．1％）,输尿管断裂2例（8．3％）,结石上移2例（8．3％）。结论：输尿管镜术中困难和并发症与操作者的经验密切相关,掌握手术适应证,术前加强培训,熟练操作技巧,是减少手术失败率和并发症的关键。     

增加输尿管硬镜手术难度和风险的病变分型

目的 总结引起输尿管硬镜术操作困难和不良事件的常见病变类型及其临床特征.方法 回顾性分析2001年1月至2010年12月行经尿道输尿管镜检查和(或)治疗输尿管病变317例患者的资料,其中手术操作困难60例.男34例,女26例;年龄18～71岁,平均37岁.按输尿管病变特征分为5型:Ⅰ型,结石性狭窄; Ⅱ型,肿瘤性狭窄;Ⅲ型,非先天性良性狭窄;Ⅳ型,先天性狭窄或纤细;Ⅴ型,扩张迂曲.统计手术时间、并发症、中转开放情况,分析相应的处理措施.结果 60例患者手术时间31～200 min,平均75 min.术中发生并发症9例,其中黏膜出血4例、输尿管穿孔3例、黏膜下假道2例.中转开放术式11例.5例因进镜困难仅放置双J管引流.55例获随访,随访时间3～110个月,平均17个月.治愈48例,好转5例,无效2例.结论 5种类型输尿管病变可增加输尿管硬镜操作难度和风险,手术操作需谨慎,必要时需终止手术或中转其他术式.

Abstract：

Objective To summarize the common types and clinical characteristics of ureter disease;which can increase manipulation difficulties and adverse events during rigid ureteroscopic procedures. Methods From Jan 2001 to Dec 2010,our team performed 317 rigid ureteroscopic Drocedures for ureteroscopic examination or treatment;including 60 difficult procedures(34 male and 26 female).The mean age of the patients was 37 years (range,18 to 71).The ureteral diseases were classifted into five types according to the pathological characteristics:Type Ⅰ calculous stenosis,Type Ⅱ neoplastic stenosis;Type Ⅲ non-congenital stenosis,Type Ⅳ congenital stenosis,Type Ⅴ expansion of tortuous ureters.The operative time,complications,and conversion to open surgery were evaluated,and the therapeutic methods were analyzed. Results Of the 60 difficuhly-manipulated procedures,the mean manipulated time was 75 min (range,31 to 200).Intra-operative complications occurred in 9 procedures,including 4 cases of mucosal bleeding,2 cases of submucosaI false passage and 3 cases of ureteral perforation.Eleven procedures were converted to open surgery. In five procedures only a double J tube was inserted for drainage due to the difficulty of entering the ureter.Fiftyfive patients were followed up for 17 months (range,3 to 110);48 patients were cured,5 patients improved and 2 patients were unchanged. Conclusions The five types of ureteral disease can increase operative difficulties and risks of rigid ureteroscopic procedures.We should be cautious during surgery and should stop manipulation or convert to other surgeries if necessary.     

局麻下输尿管镜钬激光碎石术治疗输尿管结石86例临床分析

目的 探讨局麻下输尿管镜钬激光碎石术治疗输尿管结石的有效性及安全性.方法 回顾性分析2008年5月～2010年5月收治的在局麻下应用输尿管镜钬激光碎石术治疗输尿管结石86例患者的临床资料.所有患者均有轻～中度肾积水,18例合并结石远端输尿管狭窄,19例合并单纯息肉,25例合并息肉包裹结石,13例为体外冲击波碎石(ESW...     

Ectopic ureter without urinary incontinence despite ureteric orifice in the vestibulum: report of one case

This is one case of ectopic ureter which lacked urinary incontinence despite ureteric orifice in the vestibulum. Case: A 20-year-old woman complained of miction pain. On examination, we found a small orifice in the vestibulum. DIP revealed slight hydronephrosis in the left contracted kidney and normal pyelogram in the right kidney. On cystoscopy, the bilateral ureteral orifices were normal, but we found the head of a catheter placed in the orifice of the vestibulum was passing under the mucosa of the bladder. The abnormal lumen was recognized by introducing an opaque medium through a catheter placed into the orifice of the vestibulum. The diagnosis was an abnormal left ureteral ectopic opening into the vestibulum with left complete duplication of renal pelvis and ureter. Left heminephro-ureterectomy was performed. Some discussions about the ectopic ureteral orifice without incontinence were conducted.