摘要
摘要目的探讨腹腔镜手术治疗钬激光碎石术后输尿管狭窄的效果。
方法回顾性分析2009年1月至2017年9月收治的67例因输尿管结石行输尿管镜或经皮肾镜钬激光碎石术后发生输尿管狭窄患者的临床资料。男38例，女29例。年龄21～62岁，平均37岁。47例因腰痛入院，其中8例伴发热。20例为术后随访发现。输尿管上、中、下段结石术后狭窄例数分别为19、18、30例；其中输尿管完全闭锁者17例。6例有2次钬激光碎石术史，2例有3次钬激光碎石术史。11例曾行1次输尿管支架置入术扩张患侧输尿管；2例曾行2次输尿管支架置入术，并在第2次置入2根双J管；2例曾行输尿管镜输尿管狭窄段内切开，拔除双J管后症状反复。术前患者肾盂积水程度：重度25例，中度27例，轻度15例。肾集合系统分离平均（3.85±0.58）cm。术前血清肌酐46～258 μmol/L，平均115 μmol/L。手术采用经腹腔途径或经后腹腔途径。52例行输尿管狭窄段切除＋端端吻合术。镜下寻及输尿管狭窄段并游离，狭窄段长度0.5～4.5 cm，将狭窄段切除，输尿管断端剪成斜面后用可吸收线行端端吻合，输尿管内置入F7双J管。15例行输尿管膀胱再植术，将输尿管于狭窄段近端离断，将正常输尿管末端形成乳头后与膀胱吻合。
结果本组67例手术均顺利完成，手术时间65～160 min，平均82 min。术中出血量20～300 ml，平均56 ml。术后3例出现低热，应用抗生素后体温恢复正常；6例出现轻度腰痛症状，予对症治疗后缓解。术后2～3个月拔除双J管。拔管后随访3～24个月，平均12个月，患者腰痛症状均明显缓解。术后复查患者集合系统分离（1.25±0.36）cm；血清肌酐47～165μmol/L，平均75.8μmol/L。67例患者患肾功能均未再明显恶化。
结论腹腔镜输尿管狭窄段切除＋输尿管端端吻合术或输尿管膀胱再植术治疗钬激光碎石术后输尿管狭窄是一种微创、安全、有效的治疗方式。
ObjectiveTo explore the therapeutic effect of laparoscopic surgery for complicated ureteral strictures after Holmium laser lithotripsy.
MethodsThere were 67 patients with ureteral stenosis after ureteroscopic lithotripsy or percutaneous nephrolithotomy Holmium laser lithotripsy from January 2009 to September 2017. There were 38 males and 29 females. The average age of patients was 37 years old（rang 21-62 years）. 47 cases were hospitalized because of osphyalgia, among whom 8 cases had fever. There were 19 cases of upper ureteral calculi postoperative stenosis, 18 cases of middle ureteral calculi postoperative stenosis and 30 cases of lower ureteral calculi postoperative stenosis, 17 cases of whom had complete atresia. 6 patients had received twice Holmium laser lithotripsy. Two patients had received triple Holmium laser lithotripsy. In 67 cases, 11 cases had received a ureteral stent placement to dilate the affected ureter. 2 cases had received twice ureteral stent placements, two double-J tubes were placed in the two stage surgery. 2 cases had received treatment of incision inside the ureteral stricture by ureteroscope, but symptoms recurred after removal of the double-J tube. There were 15 cases of mild hydronephrosis before surgery, moderate hydronephrosis in 27 cases, severe hydronephrosis in 25 cases.The depth of separation of the renal collecting system was （3.85±0.58）cm, preoperative serum creatinine was 115μmol/L on average（range 46-258 μmol/L）. The surgery was done by the abdominal pathway or posterior abdominal pathway. 52 patients had ureteral stenosis resection plus ureter end anastomosis, 15 patients had ureteral bladder replantation.
ResultsAll the patients had successful surgery. The operation time was 65-160 min, and the average operation time was 82 min; the intraoperative blood loss was about 20-300 ml, and the average blood loss was about 56 ml; Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic. The stent was removed after 2-3 months and patients were followed up for 5-24 months after removing the double-J tube, with an average of 12 months. The patients with osphyalgia were significantly relieved. The separation of the renal collecting system was reduced to（3.85±0.58）cm, postoperative serum creatinine was 75.8 μmol/L on average（range 47-165 μmol/L）. Renal function stop deterioration in 67 patients.
ConclusionThe operation of laparoscopic ureteral strictures resection plus ureter end anastomosis or ureteral bladder replantation after ureteral strictures due to the use of Holmium laser lithotripsy is the minimally invasive, safe and effective treatment.
作者
陈华
刘泰荣
宋乐明
刘生锋
黄永明
Chert Hua , Liu Tairong , Song Leming , Liu Shengfeng , Huang Yongming.(Department of Urology, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou 341000, Chin)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第3期218-221,共4页
Chinese Journal of Urology
关键词
钬激光碎石
输尿管狭窄
腹腔镜
Holmium laser lithotripsy
Ureteral strictures
Laparoscopy
