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

何文强; 屈颖伟; 郑聪; 王光策; 陈铸; 王锁刚; 卢鹏

doi:10.13201/j.issn.1001-1420.2019.07.010

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

- 1. 河南中医药大学第一附属医院泌尿外科(郑州, 450000);
- 2. 太康县第二人民医院泌尿外科

详细信息

通讯作者: 王光策,E-mail:wgc460u@126.com

中图分类号: R693

收稿日期: 2019-03-18

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

- 1. Department of Urology, First Affiliated Hospital of Henan University of CM, Zhengzhou, 450000, China;
- 2. Department of Urology, Taikang Second People's Hospital

More Information

Corresponding author: WANG Guangce, E-mail: wgc460u@126.com

Received Date: 18 March 2019

摘要

摘要: 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。
- 经皮肾镜 /
- 输尿管结石 /
- 输尿管软镜 /
- 钬激光
Abstract: 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.
- percutaneous nephroscope /
- ureteral calculi /
- flexible ureteroscope /
- holmium laser

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参考文献(15)

[1]	Inoue T, Okada S, Hamamoto S, et al.Current trends and pitfalls in endoscopic treatment of urolithiasis[J].Int J Urol, 2018, 25 (2):121-133.
[2]	Okhunov Z, Duty B, Smith A D, et al.Management of urolithiasis in patients after urinary diversions[J].BJUInt, 2011, 108 (3):330-336.
[3]	Güler A, Erbin A, Ucpinar B, et al.Comparison of miniaturized percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for the treatment of large kidney stones:a randomized prospective study[J].Urolithiasis, 2019, 47 (3):289-295.
[4]	张世国, 何巍, 李志刚, 等.腔内钬激光治疗输尿管结石合并远端输尿管狭窄[J].中国医师进修杂志, 2015, 38 (3):201-204.
[5]	Yuan S, Wang J, Zhang Y.Efficacy analysis and clinical application of flexible ureteroscope and rigid ureteroscope in the treatment of ureteral calculi[J].Int J Clin Exp Med, 2018, 11 (11):12605-12610.
[6]	Takagi T, Go T, Takayasu H, et al.Fiberoptic pyeloureteroscope[J].Surgery, 1971, 70 (5):661-663.
[7]	丁新民, 蒋国华, 温洪波, 等.顺行与逆行输尿管镜下钬激光碎石术治疗合并感染的输尿管结石比较[J].中华腔镜泌尿外科杂志 (电子版), 2012, 6 (2):106-109.
[8]	彭国辉, 李汉忠, 曹满超, 等.顺行输尿管软镜碎石术在输尿管下段复杂病变中的应用[J].中华腔镜泌尿外科杂志 (电子版), 2016, 10 (1):51-54.
[9]	Olson L, Satherley H, Cleaveland P, et al.Retrograde Endourological Management of Upper Urinary Tract Abnormalities in Patients with Ileal Conduit Urinary Diversion:A Dual-Center Experience[J].J Endourol, 2017, 31 (9):271-271.
[10]	屈峰, 李笑弓, 张古田, 等.顺行输尿管软镜碎石术治疗尿流改道后上尿路结石分析[J].临床泌尿外科杂志, 2013, 28 (3):166-168, 171.
[11]	Inoue T, Okada S, Hamamoto S, et al.Current trends and pitfalls in endoscopic treatment of urolithiasis[J].Int J Urol, 2018, 25 (2):121-133.
[12]	雷鸣, 袁坚, 曾国华, 等.经尿道输尿管镜术治疗输尿管结石合并远端输尿管狭窄106例[J].实用医学杂志, 2006, 22 (24):2876-2877.
[13]	Harmon W J, Sershon P D, Blute M L, et al.Ureteroscopy:Current Practice and Long-Term Complications[J].J Urol, 1997, 157 (1):28-32.
[14]	Doizi S, Kamphuis G, Giusti G, et al.First clinical evaluation of a new single-use flexible ureteroscope (LithoVueTM):a European prospective multicentric feasibility study[J].World J Urol, 2017, 35 (5):809-818.
[15]	Söylemez H, Yıldırım K, Utangac M M, et al.A new alternative for difficult ureter in adult patients:no need to dilate ureter via a balloon or a stent with the aid of 4.5 F semirigid ureteroscope[J].J Endourol, 2016, 30 (6):650-654.