输尿管硬镜临床运用418例体会

目的：提高输尿管硬镜临床运用技术。方法：回顾分析输尿管硬镜诊治418例输尿管疾病的临床资料。结果：采用输尿管导管引导,手控间断式水压扩张法直接进镜。手术成功率为97.0%。手术中并发输尿管穿孔2(0.5%)。结论：输尿管硬镜进镜时采用输尿管导管引导,手控间断式水压扩张法直接进镜,可简化操作,缩短手术时间,手术成功率高,并发症少,且可避免因灌注压过大而致结石上移。根据输尿管病变的不同,采用相应的治疗方法,疗效满意。     

自制输尿管镜针状电刀治疗输尿管狭窄

目的探讨自制输尿管镜针状电刀在治疗输尿管狭窄中的应用价值. 方法对输尿管切开取石术后狭窄24例,息肉39例,输尿管先天性狭窄4例采用自制输尿管镜针状电刀在输尿管镜下行切开术. 结果手术时间10～30 min,术中出血量5～20 ml.随访3个月,53例(79.1%)有效,10例(14.9%)好转,4例(6.0%)无效,无严重并发症发生. 结论自制输尿管镜针状电刀治疗输尿管狭窄操作容易.     

输尿管肾镜直视下套石蓝取石的体会

应用ＷＯＬＦ输尿管肾镜直视下套石蓝取石法治疗１８９例输尿管结石，其中６７例为ＥＳＷＬ后结石未粉碎而再行输尿管肾镜套石蓝取石，１４例有肾绞痛和血尿症状而Ｂ超和ＩＶＰ未见明显结石，经输尿管肾镜探查证实为输尿管结石并行套石蓝取石。结果：套石蓝取石成功１７４例，总有效率为９２．１％，术后并发高热４例，均经对症处理治愈；输尿管穿孔８例，均立即行开放手术；输尿管粘膜脱垂１例，行保守治疗。其并发症发生率为７％。     

双套管软镜鞘的初步临床应用

输尿管软镜碎石术中输尿管软镜鞘的置入有可能损伤输尿管。我们自主研发了一种双套管软镜鞘,配合输尿管硬镜直视下置入患侧肾盂输尿管交界处,行输尿管软镜钬激光碎石术,一期治疗肾结石13例,术后复查CT示13例输尿管正常,提示双套管可视软镜鞘安全、有效。     

复杂输尿管条件下的分期输尿管镜术

目的 探讨输尿管镜术中应对输尿管缩窄、扭曲、痉挛,或黏膜游离度大等复杂状况的有效方法.方法 2005-2008年收治因输尿管缩窄(28例)、扭曲(7例)、痉挛(11例)或黏膜游离度大(10例)等原因致术中无法安全顺利进镜的患者.均为单侧输尿管结石或肾盂肾盏内结石.均行IVU检查明确结石部位及分肾功能.其中结石位于输尿管中下段20例,上段21例,肾盂或肾盏内结石15例.肾盂或肾盏内结石直径1.0～1.8 cm,平均1.4 cm;输尿管结石直径0.8～1.8 cm,平均1.1 cm.肾盂扩张1.4～3.0 cm,平均2.2 cm.采用9.8 F Wolf输尿管硬镜,进镜困难者尝试换用8 F Storz硬镜,仍无法顺利进镜者改二期手术.C臂X线机监视下将超滑导丝经梗阻部位进入肾盂,留置5 F双J管.术后预防性使用抗生素3 d.2周后拔除双J管,并以输尿管硬镜处理输尿管内结石,使用输尿管软镜处理肾盂肾盏内结石.结果 56例放弃一期手术后均成功留置双J管.41例输尿管结石中,16例输尿管上段结石被推回肾盂内.二期输尿管镜手术中,56例均成功进镜,25例输尿管结石以输尿管硬镜成功碎石,31例肾盂肾盏内结石以输尿管软镜成功碎石.结论 对于因输尿管缩窄、痉挛、扭曲或黏膜游离度大导致无法安全顺利进镜患者,安置导丝留置双J管2周后行输尿管镜手术常可顺利进镜.一期术后应预防性使用抗生素.

Abstract：

Objective To discuss the feasibility and benefits of staged ureteroscopic laser lithotripsy in complicated cases. Methods From May 2005 to May 2008, the staged ureteroscopic procedure was done in 56 cases for ureteric stricture, kinking, spasm or high mobility of ureteric mucosa. Encountering difficulties, with the guide wire settled in place, the endoscopic procedure was ended and a ureteral stent was set. A second ureteroscopic procedure was carried out two weeks later. Results There was no difficulty for the insertion and the advancing of the ureteroscope two weeks later in all 56 cases. Among the 41 cases previously having the ureteric calculi, the stone was pushed into the kidney by the stent in 16 cases. There was no surgical complication during the second procedure. After three months the complete evacuation rate of the calculus was 96.4%. No patient experienced a fever >39.1 ℃ after the first attempt. Conclusions For complicated cases, such as ureteric stricture, spasm, kinking and high mobility of the ureteric mucosa which hinder the safe advancing of the ureteroscope, staged ureteroscopic procedure might be a safe and effective choice.     

输尿管镜气压弹道碎石治疗小儿输尿管结石体会

目的　探讨输尿管镜气压弹道碎石治疗小儿输尿管结石的效果及并发症。方法　对 10例小儿输尿管中下段结石进行输尿管镜气压弹道碎石。结果　 9例碎石成功并完全排出结石 ,1例未成功 ,1例发生输尿管损伤。结论　输尿管镜气压弹道碎石在操作熟练情况下是治疗小儿输尿管下段结石的理想方法。     

输尿管镜下气压弹道碎石术治疗输尿管结石80例体会

目的探讨应用输尿管镜气压弹道碎石术(URL)治疗输尿管结石的疗效。方法对80例输尿管结石患者实施URS治疗,回顾性分析患者的临床资料。结果 80例中75例(93.7%)一次性碎石成功,3例再次行URL治疗,结石完全排出。15例患者术后1～3 d出现低热或轻度肾绞痛,6例出现肉眼血尿,均经对症治疗后消失。未发生大出血及感染等并发症。2例因输尿管穿孔中转开放性手术,术后恢复良好。结论 URL治疗输尿管中、下段结石成功率高,创伤小,术后并发症少,效果肯定。     

自制输尿管镜钩形电刀治疗输尿管狭窄21例

目的探讨自制输尿管镜钩形电刀在治疗输尿管狭窄中的应用价值。方法对输尿管切开取石术后、炎性和息肉等继发性狭窄18例,输尿管先天性狭窄3例采用自制输尿管镜钩形电刀在输尿管镜下行切开术。结果手术时间10~25min,术中出血量5~20ml。随访3~6个月,17例(81%)有效,3例(14.3%)好转,1例(4.7%)无效,无严重并发症发生。结论自制输尿管镜钩形电刀治疗输尿管狭窄操作简便,安全有效。     

输尿管肾镜直视下套石篮取石的体会

应用ＷＯＬＦ输尿管肾镜直视下套石篮取石法治疗１８９例输尿管结石，其中６７例为ＥＳＷＬ后结石未粉碎而再行输尿管肾镜套石篮取石，１４例有肾绞痛和血尿症状而Ｂ超和ＩＶＰ未见明显结石，经输尿管肾镜探查证实为输尿管结石并行套石篮取石。结果：套石篮取石成功１７４例，总有效率为９２．１％。术后并发高热４例，均经对症处理治愈；输尿管穿孔８例，均立即行开放手术；输尿管粘膜脱垂１例，行保守治疗。其并发症发生率为７％（１３／１８９）。认为，应用此术治疗输尿管结石必须正确掌握适应证；术中扩张输尿管口是减少术后并发症、提高成功率的关键，此术具有创伤小、手术及住院时间短等优点，是治疗输尿管结石较为理想的方法。     

Early experience with direct vision electrohydraulic lithotripsy of ureteral calculi

Rigid ureteroscopy is now an established technique for the management of ureteral stones. Manipulation of calculi can be done under direct vision using flexible forceps or stone baskets with increased safety and efficacy. We also have used a 5F electrohydraulic lithotripsy electrode to disintegrate stones that were too large to be removed by manipulation. Between October 1982 and January 1984, 36 ureteroscopies were performed for the removal of ureteral stones. In 26 cases (72 per cent) the stone was removed successfully. Electrohydraulic lithotripsy was used successfully to remove the stone in 9 cases (24 per cent) and there were no immediate complications. Followup with excretory urography in 7 of these patients 2 to 18 months after lithotripsy failed to reveal any evidence of long-term complications. We conclude that electrohydraulic lithotripsy under direct vision can be done safely if certain guidelines are adhered to strictly.     

腔镜下处理输尿管结石并息肉

目的　介绍输尿管镜下处理输尿管结石并息肉的经验。　方法　１９９１ 年７ 月至１９９８年１１ 月,对１ ８４７ 例输尿管结石行２ ０５９ 例次输尿管镜检查及治疗,其中１０７ 例检查前曾先后行１ ～５次体外冲击波碎石（ＥＳＷＬ） 未获成功。　结果　１ ８４７ 例输尿管结石中并发息肉５５３ 例（２９ ．９ ％ ） ,其中４５０ 例在输尿管镜下处理成功（８１ ．４ ％ ） 。　结论　输尿管结石并息肉为常见病;输尿管结石嵌顿时间超过３ 个月,肾积水程度与结石大小不相符的患者不宜行ＥＳＷＬ;输尿管镜下行输尿管息肉切除及气压弹道碎石治疗效果满意。     

Management of ureteroscopic ureteral injuries

Ureteroscopy will continue to have a place in the management of renal stone disease and is invaluable to evaluate other types of ureteral lesions. Although ureteroscopy can be performed safely in most cases, it is invasive and there is a potential for ureteral injury. The well-trained urologic surgeon should be familiar with techniques to minimize the incidence of complications of ureteroscopy. However, faced with a ureteral complication, no matter the severity, the surgeon should have the ingenuity and expertise to restore anatomic integrity to the renal unit.     

Initial experience with a newly developed antirefluxive ureter stent

The objective of this study was to assess the functional efficacy of newly developed antirefluxive ureter stents (DJ), by performing immediate post-stenting cystograms on patients with acute ureteral obstruction requiring a DJ stent, and assessing stent-related symptoms by means of ureteral stent symptoms questionnaire (USSQ). Patients with acute hydronephrosis requiring internal drainage were randomized to receive either an antirefluxive DJ or a conventional DJ (7 Fr., 26 cm, polyurethane, Urovision(?), Germany). Mean stone size was 6.64 ± 3.33 and 6.5 ± 3.54 mm. Immediately after correct placement of the DJ, 200 ml of diluted contrast media was introduced into the bladder under fluoroscopic control to detect vesicoureteral reflux (VUR). Patients completed German versions of the USSQ on days 2 and 7 following stent placement, and 1 week after stent removal. The results were analyzed. 13 conventional and 16 antirefluxive stents were placed in 29 patients. Reflux was documented in eight conventionally stented patients (62.5%). Two of the 16 patients with antirefluxive stents (22%) presented reflux. 1 week after stent implantation, the mean pain value was 1.1 in the antirefluxive group and 3 in the standard group (p < 0.062). Flank pain during micturition occurred after 2 days in seven patients (58%) with standard stents and in three patients (33%) with antirefluxive stents (p < 0.23). 1 week after stent insertion, flank pain had dropped to 40% in the standard group and 11% in the antirefluxive group (p < 0.3). Our initial experience showed that the antirefluxive system might be effective in terms of reflux prevention and reduction of stent related symptoms especially during sexual intercourse.     

Initial clinical experience with full-length metal ureteral stents for obstructive ureteral stenosis

OBJECTIVES: Long-term ureteral stenting is used to ensure urinary drainage if a reconstructive approach or a release of an extrinsic obstruction is not possible. In this contribution, a long-term experience with a new full-length, metal indwelling stent is presented. METHODS: Fourteen patients with ureteral obstruction received full metal indwelling stents in 18 collecting systems (benign disease in 5 and malignant disease in 13). Stent placement was performed cystoscopically under fluoroscopic guidance. Follow-up was done every 3 months with ultrasonographic examination, creatinine levels, and a visual analog pain score. RESULTS: Eight stents were removed, whereas eight are still in situ. One patient without stent-related problems died because of progressive rectal cancer 9 months after bilateral stent insertion. Mean stent duration (8 stents still in situ) is 8.6 months, whereas mean stent duration for benign and malignant disease is 11.8 (median 13) and 7.3 (median 6) months, respectively (p<0.05). All removed stents were extracted endoscopically without any problems and had no incrustation except two. Neither migration nor mechanical damage was observed. CONCLUSION: This novel stent is easy to insert and remove. It is an option for patients in which a surgical reconstruction of the obstructed ureter is not possible. Stents have been developed further and are now available in various lengths. This might result in a reduction of problems associated with inadequate stent length and should increase patient comfort and stent durability.     

Transurethral ureteroscopic removal of ureteral calculi

Rigid ureteroscopy was used for transurethral removal of ureteral stones. Calculi were extracted under direct vision using flexible grasping forceps or a stone basket. If the size of the stone precluded the use of these techniques, we disintegrated the stone using an electro-hydraulic lithotriptor (EHL) or ultrasonic lithotriptor (USL). Between January, 1985 and October, 1985, 35 ureteroscopic procedures were performed for removal of ureteral stones. In 27 cases (77%) the stone was removed successfully. All stones could be removed in mid and lower ureter. However, in upper ureter, the success rate was only 50%. In 8 instances, ureteroscopy failed to remove the ureteral calculus and 6 underwent percutaneous nephrolithotomy, 2 open surgery. Of the ureteral stones, 12 were removed with grasping forceps or a basket manipulation. EHL and USL were used successfully to remove calculi in 15 cases. To make smooth passage of the ureteroscope, a 6F UPJ occlusion balloon catheter was introduced into the ureter and the balloon was inflated in the intramural ureter for 24 hours preoperatively. We have found this to be a useful procedure for smooth passage of the ureteroscope. Most common complication of ureteroscopic stone removal was fever (29%). In 1 case, the ureter was penetrated by the scope. The patient was treated with an indwelling ureteral catheter for 2 weeks. After the catheter was removed, an excretory urogram demonstrated normal ureter without extravasation or obstruction. We conclude that ureteroscopic stone removal can be done safely with careful passage of the scope and careful manipulation of calculi.     

输尿管壁厚度作为预测输尿管镜下治疗输尿管下段梗阻性结石的应用研究

目的 通过测量输尿管壁厚度预测输尿管镜下治疗的输尿管下段结石是否为梗阻性结石。方法 回顾性分析本院2014年2月至2018年2月共计320例接受输尿管镜手术的患者资料,通过高分辨CT平扫测量结石周围输尿管管壁厚度,通过ROC曲线分析输尿管管壁厚度,通过不同诊断分界点的灵敏度和特异度确定最佳诊断分界点。结果 320例患者中,梗阻性结石的患者为119例,患者所患结石是否合并肾周渗出、结石的数量、大小、输尿管管壁厚度均具有统计学意义（P<0.001）,通过ROC曲线分析得出分界点3.15 mm对应的诊断指数最大。结论 输尿管管壁厚度可以预测输尿管下段梗阻性结石,从而预测输尿管镜碎石术的难易度。     

输尿管镜碎石术后输尿管狭窄的治疗

目的研究输尿管镜碎石术后输尿管狭窄的治疗方法及效果。方法回顾性分析北京清华长庚医院2014年12月-2018年2月收治的输尿管镜碎石术后输尿管狭窄患者的临床资料。初次治疗、输尿管狭窄长度<2 cm的患者首选以内腔镜下治疗为主的手术方式(内腔镜下球囊扩张或球囊扩张+内切开)为内镜组,既往治疗失败或狭窄长度>2 cm的患者选择以尿路重建手术为主的治疗方式为腹腔镜/开放组,记录并观察患者术后发热、腰痛、留置输尿管支架管或肾造瘘管、超声、CT尿路造影、利尿肾图等情况。结果34例行内腔镜下治疗,11例行开放/腹腔镜尿路重建手术。内腔镜治疗病例中73.5%(25例)为初次治疗,尿路重建病例中63.6%(7例)术前有输尿管狭窄治疗史。内腔镜手术有效率44%,尿路重建术有效率76%,尿路重建术有效率为内腔镜治疗的1.73倍。结论虽然尿路重建手术有效率明显高于内腔镜下治疗,对于选择合适的病例,内腔镜手术仍可作为输尿管镜碎石术后输尿管狭窄的一线治疗。初次治疗可采用内腔镜治疗,有既往治疗史的患者则以尿路重建手术为主。