输尿管镜致医源性输尿管损伤19例分析

目的：探讨输尿管镜在临床操作中所导致的医源性输尿管损伤的原因和预防方法。方法：总结分析2001年1月-2005年7月我院开展输尿管镜治疗310例患者中所导致的医源性输尿管损伤19例的临床资料。结果：本组19例中，输尿管开口穿孔3例，输尿管开口撕裂4例，输尿管穿孔4例，输尿管开口黏膜脱套2例，输尿管黏膜下隧道5例，输尿管取石钳臂断裂1例。除1例输尿管取石钳臂断裂因断臂嵌入输尿管壁内无法取出改开放性手术外，其余18例均经捅入双J管治疗后治愈。结论：进行输尿管镜操作过程中保持视野的清晰，操作要轻柔，避免动作的粗暴，熟悉输尿管解剖及走向，正确进镜碎石是手术成功的关键，术后留置支架管能减少输尿管狭窄的并发症发生。

The Analysis about 19 medical Ureter injury from Ureteroscope

Objective To require into reasons and prevention methods of medical Ureter injury from Ureteroseope in clinical operation. Methgd To Summary and Analysis 19 medical ,Ureter injury clinical datas among 310 patients treated by Ureteroscope from 2001.1 to 2005.7 Results Among the 19 patients, 3 ureter entrance pierced, 4 ureter entrance teared, 4 ureter pierced, 2 ureter entrance mucous membrane peeled off,5 tunneled under the ureter entrance mucous membrane, 1 arm of ureteral stone holding forceps broken. Except for 1 case been changed into open operation from endoscope operation for broken arm of ureteral stone holding forceps embeded ureter wall has not been unloaded through Ureteroseope, 18 have been cured through embeded DJ tubes. Conclusion Clear eyesight, light and soft operation, having an intimate knowledge about anatomy and strike of ureter, Ureteroscope precisly be entered into ureter, are key points of good operations, remaining DJ tubes can decrease the happening of ureterostenosis.