顺行输尿管软镜治疗输尿管中下段结石合并远端输尿管复杂病变

目的:探讨经皮肾通道顺行输尿管软镜治疗输尿管中下段结石合并远端输尿管狭窄、扭曲患者的有效性及安全性。方法:回顾性分析2014年6月~2018年11月在我院行输尿管硬镜碎石术(URL)的27例输尿管中下段结石的临床资料,术中发现输尿管狭窄及扭曲严重,输尿管镜难以上行至结石处,改行俯卧位建立F24皮肾镜通道后,顺行置入输尿管导引鞘及输尿管软镜,处理结石。结果:手术时间46~139 min,平均(67±15)min,26例采用顺行输尿管软镜将输尿管结石全部清除(残石颗粒冲入膀胱),术后1~3d拔除尿管,后自行排出,均未出现气胸、肠道损伤、严重出血及输尿管脱套等严重并发症。1例改行开放取石。结论:顺行输尿管软镜在URL治疗失败的输尿管中下段结石合并远端输尿管狭窄、扭曲的治疗中,具有安全、有效、并发症少等优点。

Anterograde flexible ureteroscopy for the treatment of middle and lower ureteral calculi complicated with distal ureteral complex lesions

Objective:To evaluate the efficacy and safety of percutaneous anterograde flexible ureteroscopy in the treatment of middle and lower ureteral calculi complicated with distal ureteral stricture and distortion.Method:From June 2014 to November 2018,27 cases of middle and lower ureteral calculi who were treated with lithotomy by rigid ureteroscope were retrospectively analysed.Severe ureteral stenosis and distortion were found during the operation,and it was difficult for ureteroscope to reach the stone.After the establishment of the F24 percutaneous nephroscope channel in the prone position,the ureteral guide sheath and ureteral soft lens were placed in the anterograde direction to treat the calculi.Result:The operation time was 46-139 min,averaging(67±15)min.Twenty-six patients successfully underwent anterograde flexible ureteroscopy without pneumothorax,intestinal injury,severe bleeding,ureteral avulsion or other serious complications.However,only one patient was converted to open surgery.Conclusion:Anterograde flexible ureteroscopy has the advantages of safety,effectiveness and less complications in the treatment of middle and lower ureteral calculi combined with distal ureteral stricture and distortion after failure of rigid ureteroscopy.