逆行输尿管镜手术常见并发症及防治策略

目的探讨逆行输尿管镜手术的常见并发症及防治策略。方法回顾性分析本院2003年1月~2009年8月有随访资料的逆行输尿管镜手术1707例（1734侧）。其中男1 047例,女660例;年龄16~86岁,平均（50.31±13.62）岁;治疗1 632例,诊断75例。随访3~45个月（平均26个月）。结果术中并发症3.75%（64例）：输尿管损伤（穿孔、黏膜下假道、黏膜长段撕脱、断裂、管口裂伤）2.11%（36例）,肾脏破裂2例,膀胱破裂1例、大出血1例,尿道损伤1例,结石移位1.35%（23例）。近期（术后1月内）并发症6.21%（106例）：严重血尿（鲜血样,〉3 d）1.05%（18例）;发热（T〉38.5℃）2.52%（43例）;肾周积液0.53%（9例）;肾绞痛0.76%（13例）;双J管位置不正1.11%（19例）,移位0.23%（4例）。远期并发症0.94%（16例）：输尿管狭窄0.76%（13例）;双J管拔管困难0.18%（3例）。手术开展早期（2003年1月~2004年12月）并发症发生率（19.73%）显著高于中期（2005年1月~2006年12月）和后期（2007年1月~2009年8月）,分别为9.83%和6.24%,差异有显著性意义（P〈0.05）;而开展中期和后期阶段差异并无显著性意义（P〉0.05）。结论输尿管镜手术并发症与对适应证的掌握、操作熟练程度、术中灌注压等相关,因此,对初学者进行充分的培训是必需的。

Complications of retrograde rigid ureteroscopy and preventive strategies

Objective To evaluate the common complications and preventive strategies of retrograde rigid ureteroscopy.Methods Between January 2003 and August 2009,1 707 patients aged from 16 to 86 years underwent retrograde ureteroscopy（1 734 procedures）.We used rigid ureteroscope（Wolf 8/9.8F）for 75 diagnostic and 1 632 therapeutic procedures.The median follow-up was 26 months（ranging 3~45 months）.Results The general rate of intraoperative incidents was 3.75%,which consisted of 0.64% ureteral perforation,0.47% false passage,0.53% laceration of ureteral orifice,2 mucosal avulsions cases,1 abruption case,2 renal rupture cases,1 vesical perforation case,1 hemorrhea case,1 urethral injury case.In addition,the impossibility of accessing calculi or stone fragments because of migration during lithotripsy was 1.35%.Early postoperative complications were described in 6.21%：hematuria（3 days）1.05%,infectious fever（T38.5 ℃）2.52%,perinephric hydrops 0.53%,renal colic 0.76%,double J stent malpositioning and migration was 1.11% and 0.23% individually.We also found late complications such as 0.76% ureteral stenosis,0.18% accidents about removal of double J stent.Conclusion The complications of ureteroscopy were correlated with the unskilled manipulation,intraoperative perfusion pressure and appropriate indications.Adequate training for beginner is imperative.