一期球囊扩张联合输尿管软镜下钬激光碎石治疗输尿管狭窄合并肾结石的疗效分析
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摘要
目的:分析一期球囊扩张联合输尿管软镜下钬激光碎石治疗输尿管狭窄合并肾结石的方法和疗效。方法:2013年1月～2016年1月我院22例输尿管狭窄合并肾结石患者接受一期球囊扩张联合输尿管软镜下钬激光碎石治疗,其中男12例,女10例,年龄23～58岁;输尿管下段狭窄14例,输尿管中段狭窄2例,输尿管上段狭窄6例;输尿管狭窄段0.5～2.0cm,平均1.6cm;结石大小0.6～2.1cm,平均1.6cm。统计分析结石清除率、肾积水变化情况及并发症,对比手术前后IVU造影及CTU检查结果情况。结果:22例手术均顺利完成,术后住院时间2～7d,平均4d,输尿管软镜鞘成功置入率90.9%(20/22),2例术后高热,术后随访6～36个月,平均12个月,一期结石清除率86.4%(19/22),18例输尿管、肾积水明显改善,2例行二次球囊扩张及2例行输尿管整形术后肾积水好转。结论:一期球囊扩张联合输尿管软镜下钬激光碎石治疗输尿管狭窄合并肾结石安全、有效、微创,是一种值得推荐的新方法。
Objective:To analyze the technique and clinical effect of balloon dilation combined with flexible ureteroscopy holmium laser lithotripsy in the treatment of ureterostenosis with renal calculi.Method:From January 2013 to January 2016,22 ureterostenosis with renal calculi patients were treated.There were 12 males and 10 females with the age of 23-58 years old.There were 14 cases of lower ureterostenosis,2 cases of intermediate ureterostenosis,and 6 cases of upper ureterostenosis.The length of ureterostenosis of 22 cases were 0.5-2.0 cm with the average of 1.6 cm.The diameter of calculi were 0.6-2.1 cm with the average of 1.6 cm.All patients were treated with balloon dilation combined with flexible ureteroscopy holmium laser lithotripsy.The stone clearance rate,hydronephrosis changes,complications and IVP/CTU situation before and after surgery were analyzed.Result:All the 22 cases were completed surgery successfully.The postoperative hospital stay was 2 to 7 dwith a mean of 4 d.Ureteral access sheathes were put in successfully in 20 cases(90.9%).Two patients had hyperpyrexia.The patients were followed up for 6 to 36 months.The stone-free rate was 86.4%(19/22)on one session.Eighteen cases with hydronephrosis improved significantly.Four cases with no significant changes but improved following balloon dilation and plastic operation.Conclusion:The use of balloon dilation combined with flexible ureteroscope holmium laser lithotripsy is a safe,effective and economical treatment option in the treatment of ureterostenosis with renal calculi.
Objective:To analyze the technique and clinical effect of balloon dilation combined with flexible ureteroscopy holmium laser lithotripsy in the treatment of ureterostenosis with renal calculi.Method:From January 2013 to January 2016,22 ureterostenosis with renal calculi patients were treated.There were 12 males and 10 females with the age of 23-58 years old.There were 14 cases of lower ureterostenosis,2 cases of intermediate ureterostenosis,and 6 cases of upper ureterostenosis.The length of ureterostenosis of 22 cases were 0.5-2.0 cm with the average of 1.6 cm.The diameter of calculi were 0.6-2.1 cm with the average of 1.6 cm.All patients were treated with balloon dilation combined with flexible ureteroscopy holmium laser lithotripsy.The stone clearance rate,hydronephrosis changes,complications and IVP/CTU situation before and after surgery were analyzed.Result:All the 22 cases were completed surgery successfully.The postoperative hospital stay was 2 to 7 dwith a mean of 4 d.Ureteral access sheathes were put in successfully in 20 cases(90.9%).Two patients had hyperpyrexia.The patients were followed up for 6 to 36 months.The stone-free rate was 86.4%(19/22)on one session.Eighteen cases with hydronephrosis improved significantly.Four cases with no significant changes but improved following balloon dilation and plastic operation.Conclusion:The use of balloon dilation combined with flexible ureteroscope holmium laser lithotripsy is a safe,effective and economical treatment option in the treatment of ureterostenosis with renal calculi.
引文
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2 Corcoran A T,Smaldone M C,Ricchiuti D D,et al.Management of benign ureteral strictures in the endoscopic era[J].J Endourol,2009,23(11):19 09-1912.
3 Parente Hernández,Angulo Madero J M,Romero Ruiz R M,et al.Medium-term results of the endourological management with balloon dilatation of the ureteropelvic junction stenosis in infants[J].Actas Urol Esp,2009,33(4):422-428.
4 Kriegshauser J S,Naidu S G,Chang Y H,et al.The accordion sign in the transplant ureter:ramifications during balloon dilation of strietures[J].Cardiovasc Intervent Radiol,2015,38(2):430-434.
5徐庆康,沈伟华,徐哲,等.经皮肾镜联合球囊扩张治疗复发性肾结石合并输尿管上段狭窄18例报告[J].中华泌尿外科杂志,2012,33(5):340-343.
6 Kuntz N J,Neisius A,Tsivian M,et al.TsivianMatvey.et al.Balloon Dilation of the Ureter:A Contemporary Review of Outcomes and Complications[J].J Urol,2015,194(2):413-417.
7王俊,郭志新,吴洪磊,等.输尿管软镜钬激光碎石术治疗输尿管上段结石并发输尿管狭窄的危险因素分析[J].临床泌尿外科杂志,2018,33(7):532-536.
8刘年,李杰,朱鑫,等.经皮肾镜与输尿管镜治疗输尿管上段直径>1.5cm结石的疗效比较分析[J].临床泌尿外科杂志,2017,32(8):631-634.
9 Zhong W,Leto G,Wang L,et al.Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy:a study of risk factors[J].J Endourol,2015,29(1):25-28.
2 Corcoran A T,Smaldone M C,Ricchiuti D D,et al.Management of benign ureteral strictures in the endoscopic era[J].J Endourol,2009,23(11):19 09-1912.
3 Parente Hernández,Angulo Madero J M,Romero Ruiz R M,et al.Medium-term results of the endourological management with balloon dilatation of the ureteropelvic junction stenosis in infants[J].Actas Urol Esp,2009,33(4):422-428.
4 Kriegshauser J S,Naidu S G,Chang Y H,et al.The accordion sign in the transplant ureter:ramifications during balloon dilation of strietures[J].Cardiovasc Intervent Radiol,2015,38(2):430-434.
5徐庆康,沈伟华,徐哲,等.经皮肾镜联合球囊扩张治疗复发性肾结石合并输尿管上段狭窄18例报告[J].中华泌尿外科杂志,2012,33(5):340-343.
6 Kuntz N J,Neisius A,Tsivian M,et al.TsivianMatvey.et al.Balloon Dilation of the Ureter:A Contemporary Review of Outcomes and Complications[J].J Urol,2015,194(2):413-417.
7王俊,郭志新,吴洪磊,等.输尿管软镜钬激光碎石术治疗输尿管上段结石并发输尿管狭窄的危险因素分析[J].临床泌尿外科杂志,2018,33(7):532-536.
8刘年,李杰,朱鑫,等.经皮肾镜与输尿管镜治疗输尿管上段直径>1.5cm结石的疗效比较分析[J].临床泌尿外科杂志,2017,32(8):631-634.
9 Zhong W,Leto G,Wang L,et al.Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy:a study of risk factors[J].J Endourol,2015,29(1):25-28.