输尿管镜下钬激光碎石术后并发输尿管狭窄的回顾分析
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摘要
目的回顾分析输尿管镜下行钬激光碎石术后并发输尿管狭窄的原因,并研究有效的预防措施和处理方案。方法选取2011年3月至2018年3月本院收治的600例结石患者进行研究分析,收集其病例资料,总结术后结石患者的输尿管狭窄特点和处理方法。结果 600例患者经输尿管镜下钬激光碎石术术后,共发现40例输尿管狭窄(6.67%,40/600),其中大部分患者在拔除双J管后的30 d内有腰部疼痛,其余均无明显症状。CT、B超复查显示,无结石梗阻,积水恢复至术前大小,明显加重,通过逆性插管造影,能够清楚观察到输尿管狭窄,可发现10例输尿管闭锁者(1.67%,10/600)。按照狭窄部位分为10例上段(4.12%,10/243)、4例中段(2.78%,4/144)、26例下段(12.21%,26/213)。10例输尿管闭锁者的平均结石大小为15.5mm,其梗阻侧肾的积水为38.62mm,为嵌顿结石状,与梗阻部位不存在相关性。40例输尿管狭窄患者中有10例患者进行输尿管钬激光内切除,术后均留置了双J管,其留置时间为3～6个月;10例输尿管闭锁患者中有6例进行输尿管狭窄段切除端吻合术,4例进行闭锁行输尿管膀胱再植术;16例患者行钬激光内切开术,4例患者接受二次输尿管狭窄开放手术,其中有1例患者为严重肾功能受损者,已予以肾切除术治疗。结论对结石患者行输尿管镜下钬激光碎石术会对输尿管造成一定的损伤,可造成输尿管狭窄,临床医师应关注其术后并发症处理,尤其关注对嵌顿性结石患者的操作技巧和术后并发症预防及处理,力求减轻输尿管狭窄的伤害,促进患者早日康复出院。
Objective To retrospectively analyze the causes of ureteral stricture after ureteroscopic holmium laser lithotripsy,and to study effective preventive measures and treatment plans. Methods Sixty-six patients with stones admitted to our hospital from March 2011 to March 2018 were selected for study and analysis. The case data were collected to summarize the characteristics and treatment of ureteral stricture in patients with postoperative calculi. Results A total of 40 ureteral strictures(6.67%, 40/600) were found in 600 patients after ureteroscopic holmium laser lithotripsy. Most of the patients had lumbar pain within 30 days after removal of the double J tube. There were no obvious symptoms. CT, B-ultrasound showed no stone obstruction, stagnant water returned to preoperative size, significantly increased, by retrograde intubation angiography, ureteral stricture can be clearly observed, 10 cases of ureteral atresia can be found(1.67%, 10/600). According to the stenosis, it was divided into 10 cases(4.12%, 10/243), 4 cases(2.78%, 4/144), and 26 cases(12.21%, 26/213). The average stone size of 10 cases of ureteral atresia was 15.5 mm, and the obstructive side of the kidney was38.62 mm, which was incarcerated calculus, and had no correlation with the obstructive site; 10 of the 40 patients underwent holmium laser resection of the ureter. Double J tubes were retained after the operation. The indwelling time was 3 to 6 months; Of the 10 patients with ureteral atresia, 6 underwent ureteral stricture resection and end-to-end anastomosis, and 4 underwent ureterobladder replantation.16 patients underwent holmium laser endoscopic incision, 4 patients underwent second ureteral stricture surgery, of which 1 patient had severe renal impairment and had been treated with nephrectomy. Conclusion Ureteroscopy with ureteroscopic holmium laser lithotripsy can cause certain damage to the ureter, which can cause ureteral stricture. Clinicians should pay attention to the treatment of postoperative complications, especially the operation skills of patients with incarcerated stones. Prevention and treatment of postoperative complications, strive to reduce the damage of ureteral stricture, and promote the patient's early recovery and discharge.
Objective To retrospectively analyze the causes of ureteral stricture after ureteroscopic holmium laser lithotripsy,and to study effective preventive measures and treatment plans. Methods Sixty-six patients with stones admitted to our hospital from March 2011 to March 2018 were selected for study and analysis. The case data were collected to summarize the characteristics and treatment of ureteral stricture in patients with postoperative calculi. Results A total of 40 ureteral strictures(6.67%, 40/600) were found in 600 patients after ureteroscopic holmium laser lithotripsy. Most of the patients had lumbar pain within 30 days after removal of the double J tube. There were no obvious symptoms. CT, B-ultrasound showed no stone obstruction, stagnant water returned to preoperative size, significantly increased, by retrograde intubation angiography, ureteral stricture can be clearly observed, 10 cases of ureteral atresia can be found(1.67%, 10/600). According to the stenosis, it was divided into 10 cases(4.12%, 10/243), 4 cases(2.78%, 4/144), and 26 cases(12.21%, 26/213). The average stone size of 10 cases of ureteral atresia was 15.5 mm, and the obstructive side of the kidney was38.62 mm, which was incarcerated calculus, and had no correlation with the obstructive site; 10 of the 40 patients underwent holmium laser resection of the ureter. Double J tubes were retained after the operation. The indwelling time was 3 to 6 months; Of the 10 patients with ureteral atresia, 6 underwent ureteral stricture resection and end-to-end anastomosis, and 4 underwent ureterobladder replantation.16 patients underwent holmium laser endoscopic incision, 4 patients underwent second ureteral stricture surgery, of which 1 patient had severe renal impairment and had been treated with nephrectomy. Conclusion Ureteroscopy with ureteroscopic holmium laser lithotripsy can cause certain damage to the ureter, which can cause ureteral stricture. Clinicians should pay attention to the treatment of postoperative complications, especially the operation skills of patients with incarcerated stones. Prevention and treatment of postoperative complications, strive to reduce the damage of ureteral stricture, and promote the patient's early recovery and discharge.
引文
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[5]黄跃胜,黄海鹏,朱心燊.输尿管镜下钬激光碎石术对结石清除率术后并发症及临床疗效的影响[J].河北医学,2017,23(1):152-154.
[6]周均洪,唐炎权,廖芝健,等.经输尿管硬通道下软硬镜钬激光碎石术治疗孤立肾上尿路结石[J].中国医师杂志,2016,18(s1):147-149.
[7]徐伟,李原学.输尿管镜下钬激光碎石术对结石清除率、术后并发症及临床疗效的影响分析[J].中国实用医药,2017,12(29):67-68.
[8]张洪波,高翔,马江伟,等.硬性输尿管镜钬激光碎石术医源性输尿管损伤原因分析和处理研究[J].微创泌尿外科杂志,2017,6(2):102-105.
[2]李艳华.输尿管镜下钬激光碎石术后留置双J管的并发症分析与临床护理干预体会[J].中国医药指南,2017,15(35):247-248.
[3]任双全,马玉田.输尿管镜下钬激光碎石治疗泌尿系结石疗效评价[J]深圳中西医结合杂志,2016,26(18):107-109.
[4]陈静华,谢芳林,肖贵林,等.兴国县输尿管镜下钬激光碎石术治疗输尿管结石490例临床分析[J].南昌大学学报(医学版),2016,56(5):4-5.
[5]黄跃胜,黄海鹏,朱心燊.输尿管镜下钬激光碎石术对结石清除率术后并发症及临床疗效的影响[J].河北医学,2017,23(1):152-154.
[6]周均洪,唐炎权,廖芝健,等.经输尿管硬通道下软硬镜钬激光碎石术治疗孤立肾上尿路结石[J].中国医师杂志,2016,18(s1):147-149.
[7]徐伟,李原学.输尿管镜下钬激光碎石术对结石清除率、术后并发症及临床疗效的影响分析[J].中国实用医药,2017,12(29):67-68.
[8]张洪波,高翔,马江伟,等.硬性输尿管镜钬激光碎石术医源性输尿管损伤原因分析和处理研究[J].微创泌尿外科杂志,2017,6(2):102-105.