摘要
目的探讨输尿管镜致输尿管严重损伤的处理方法。方法回顾性分析我院2 876例输尿管镜诊疗过程中15例输尿管严重损伤的临床资料。15例中,输尿管断裂4例,均行输尿管吻合术;输尿管全层撕脱4例,其中1例行肾下移输尿管膀胱瓣吻合,2例行回肠代输尿管术,1例行肾切除术;输尿管黏膜袖套样剥离7例,其中4例内置双J管引流,1例行输尿管膀胱瓣吻合,2例行回肠代输尿管术。结果所有患者均经随访3个月～3年,1例出现输尿管末端狭窄闭锁,行输尿管膀胱再植术后治愈,1例因反复肾感染行肾切除外,余13例均无异常。结论输尿管镜手术致输尿管严重损伤时,及时发现损伤并按损伤类型不同,分别采用输尿管吻合、输尿管膀胱吻合、回肠代输尿管等方法处理,疗效满意,预后好。
Objectives Ureteroscopy has became the major therapy approach for proximal urinary disease especially for stone disease.Iatrogenic ureteral injury occurs by the inappropriate use of ureteroscopy.The aim of this study was to discuss the treatment for severe ureter injury caused by ureteroscopy.Methods From 1999,2876 patients were treated with ureteroscopy at our institution,15 cases of severe ureteral injury occurred.Four cases of ureteral rupture were treated by ureteral realignment.Of four cases with complete ureteral avulsion,one case was treated by ureterovesicostomy,two cases were treated with ileal ureter,one case was treated with nephrectomy.Of seven cases with sleeve-like avulsion of ureteral mucosa,four cases were treated with the placement of doubleJ stent,one case received ureterovesicostomy,two cases were treated with ileal ureter.Results All patients were followed up for 3 months to 3 years,ureteral atresia occurred in one patient who underwent bladder and ureter reimplantation sucessfully.Kidney removal was done in a patient for the recurrent urinary tract infections.All the other patients got well.Conclusion Sufficient recognition of ureteral injury caused by ureteroscopy,detect the complication rapidly and choose different approach such as ureteral realignment,ureterovesicostomy or ileal ureter respectively according to the injury type is safe and feasible,and have a favorable prognosis.
出处
《中华腔镜泌尿外科杂志（电子版）》
2010年第4期17-19,共3页
Chinese Journal of Endourology(Electronic Edition)
关键词
输尿管镜
输尿管
损伤
治疗
Ureteroscopy Ureter Injury Treatment
