摘要
目的探讨顺、逆行输尿管镜下针状电极内切开方法治疗肾盂-输尿管连接部狭窄(UPJO)的疗效。方法回顾分析18例UPJO患者,原发性7例,继发性11例,合并患侧肾盏或肾盂结石(直径大于0.8cm)3例。在C臂X线机的辅助下,通过经皮肾造口顺行或逆行输尿管镜下,采用针状电极内切开技术切开UPJ处狭窄,合并结石患者同期行气压弹道碎石取石术,术中安放双(J5F)管,术后6～8周拔除。平均随访13个月。结果 18例患者手术成功,输尿管狭窄长度小于1.0cm(0.5～1.0cm),无大出血、肾周感染等并发症。拔除双J管后1及3个月复查B超及静脉肾盂造影(IVP),提示肾积水消失或较术前明显减少,UPJO狭窄段消失。4例原发性UPJO拔除双J管12个月后复查UPJO复发,改行开放手术治愈。结论选择适合UPJO患者采用针状电极行输尿管镜下顺、逆行内切开治疗有效、损伤小,适合于狭窄长度小于1.0cm的UPJO患者的治疗;当UPJO合并肾结石及其他需顺行入路情况下,首选顺行经皮肾盂内切开的方法。
【Objective】To evaluate the effectiveness of antegrade or retrograde ureteroscope endoincision with needle electrode（collings knife electrode） in the treatment of uerteropelvic junction obstruction.【Methods】We reviewed the data of 18 cases of UPJO with primary in 7 and secondary in 11（after previous open surgery） that were treated with needle electrode endoincision under the guidance of C-arm fluoroscopy.Among them,Endopyelotomy were performed on eight patients by using an antegrade（through percutaneous nephrostomy PCN） or on ten patients by using a retrograde ureteroscope endoincision approach with the needle electrode.Three patients with concurrent kidney stones were treated by minimally invasive percutaneous nephrolithotomy（PCNL） simultaneously.Double J indwelling catheter（5Fr） was inserted during operation and removed after 6-8 weeks.The mean follow-up was 13 months（range 5-33 months）.【Results】A total of 18 cases were operated on successfully.The ureteral stricture length was shorter than 1 cm（0.5～1.0 cm）.The symptom was relieved postoperatively,and no severe bleeding and perinephric abscess were observed.The stone free rate was 100%.By the first and third postoperative month,color Doppler ultrasonography and intravenous pyelography were carried out,which demonstrated that the previous hydronephrosis had reduced and uerteropelvic junction obstruction disappeared.Twelve months post-operation,4 cases of primary UPJO recurred and were cured by transferred to open surgery.【Conclusions】Antegrade or retrograde ureteroscope endoincision with needle electrode appears to be an effective minimally invasive procedure for treatment of selected patients with UPJO where the ureteral stenosis is shorter than 1 cm.In patients with concurrent stone disease or requiring antegrade ureteric access,percutaneous endopyelotomy would be suitable as a primary treatment option.
出处
《中国内镜杂志》
CSCD
北大核心
2010年第3期280-282,共3页
China Journal of Endoscopy
