腔内钬激光内切开术治疗合并近端结石的输尿管狭窄.docVIP

精品论文 参考文献 腔内钬激光内切开术治疗合并近端结石的输尿管狭窄 张良锁1 常立高2 （1彭州市中医医院泌尿外科 四川彭州 611930；2洛阳市第三人民医院 河南洛阳 471000） 【中图分类号】R695 【文献标识码】A【文章编号】1672-5085（2011）45-0156-03 【摘要】目的 探讨合并近端结石的输尿管狭窄的处理方法及疗效。方法 对41例合并近端结石的输尿管狭窄患者，经输尿管镜或经皮肾镜直视下清除结石，同期行输尿管狭窄钬激光内切开术。结果 41例输尿管狭窄患者均一次性内切开成功。1例术中损伤髂血管致大出血，经腹部按压后成功止血并留置输尿管支架管，3周后经输尿管镜粉碎结石；3例发生上尿路感染，应用抗生素后感染得到有效控制。术后平均随访7.3月，30例治愈，6例好转，总体有效率为87.8%(36/41)；5例无效，其中4例复发，经再次钬激光内切开后治愈，1例于术后复发2次，建议患者开放手术，患者拒绝，后失访。结论 钬激光内切开术治疗合并近端结石的输尿管狭窄具有效果确切、手术时间短、创伤小、恢复快、并发症小以及提高输尿管结石清除率等优点。 【关键词】输尿管结石 输尿管狭窄 钬激光 【Abstract】Objective To evaluate the efficacy of holmium:YAG laser endoureterotomy for treatment of ureteral strictures complicated with proximal calculus. Methods 41 patients with ureteral stricture complicated with proximal stones experienced the holmiumYAG laser endoureterotomy by ureteroscope or percutaneous nephroscope, and the ureteral calculi were cleared in the same period. Results All patients with ureteral stricture receved successfully one-time inside incision. 1 case underwent massive haemorrhage because of intraoperative damage of iliac-vasa, the bleeding was prevented by pressing abdomen and ureteral stent was placed sucessfully, the ureteral calculi was crushed threee weeks later;3 cases with different extent urinary tract infection were control effectively by using antibiotics. All cases were follow-up for 7.3 months on average, 30 cases were cured, 6 patients get better, the total effective rate was 87.8%(36/41); among 5 invalid cases, 4 patients recurred and cured by again endouretertomy, and 1 case recurred 2 times, our traditional operation suggestion was refused, and the patients lost follow-up.Conclusion Holmium:YAG laser endouretertomy in ureteral stricture complicated with proximal stone has many advantages such as effective, short operation time, minimally trauma, quick recovery, less complications and improving the ureteral calculi clearance, etc. 【Key words】Ureteral calculus Ureteral stricture Holmium：YAG laser 输尿管结