摘要
目的总结输尿管硬镜处理输尿管上段病变的经验及输尿管常见损伤因素,并探讨预置斑马导丝的价值及意义。方法统计1994-2012年期间经尿道输尿管硬镜手术共3 000余例,其中输尿管上段病变1 500例,均为术前已确诊的单侧输尿管上段结石或结石伴狭窄患者。其中男979例(65.27%),女521例(34.73%),平均年龄40.5(18～67)岁。结石平均长径约1.19(0.6～3.5)cm;单发结石1119例(74.60%),多发结石381例(25.40%)。行气压弹道碎石652例(43.47%),钬激光碎石536例(35.73%),超声EMS清石312例(20.80%)。所有病例随机分为两组,A组(912例,60.80%)在碎石前先预置斑马导丝越过狭窄和结石旁间隙达肾盂内,将斑马导丝妥善固定于会阴部,再继续完成狭窄扩张和碎石操作。B组(588例,39.20%)不预置斑马导丝直接碎石并完成所有操作。结果 A组一次性手术成功率和平均手术操作时间明显优于B组(P<0.05),分别为873例(95.72%)和31.33(15～65)min,521例(88.61%)和46.15(18～115)min。两组发生输尿管各类损伤共63例(4.20%),文章对预置斑马导丝的8个优点及有效预防输尿管损伤的9个高危因素分别作了阐述。结论预置斑马导丝法可提高输尿管镜处理输尿管上段结石伴狭窄的手术成功率,减少输尿管损伤及二期后续治疗机率,是安全可行且有效的方法。
Objective To summarize some experiences of ureteroscopic treatments of the upper ureteral lesions and common factors of ure- ter injury,and to study the value of presetting zebra guidewire. Methods Since 1994,1 500 patients of upper ureteral calculi or stones with stenosis had undergone transurethral ureteroscopie surgeries, including 979 male patients （65.27%）, 521 female cases （34.73%）, with an average of about 40.5 （ 18 - 67 ） years old. The average length of calculi was about 1.19 （0.6 ~ 3.5 ） cm. 1119 cases （ 74.60% ） had a single stone, while 381 cases （25.40%）had several stones. 652 cases （43.47%）had been managed for pneumatic lithotripsies, 536 cases （35.73%） for holmium laser lithotripsies, and 312 eases（20.80% ）for ultrasound EMS clear lithotripsies. All patients were whole-randomly assigned into two groups：group A（912 cases,60.80% ）was preset a zebra guidewire through the gaps besides stones and strictures up to the renal pelvis before lithotripsy or stenosis dilations. Group B（588 cases ,39.20% ）was omitted the presetting zebra guidewire. Results The success rate and average operative time in group A were significantly better than those in group B（ P 〈 0.05） ,as 873 cases（95.72% ）and 31.33 （ 15 ~ 65 ） min,521 cases （ 88.61% ） and 46.15 （ 18 ~ 115 ） rain, respectively. 63 cases （4.20%） had various ureteral injuries in the two groups. There were 8 advantages of presetting zebra guidewire and 9 risk factors of ureteral injury precautions were discussed in this paper. Conclusions Presetting zebra guidewire in ureteroscopic treatment upper ureteral diseases can increase the surgical success rate ,decrease follow-up treatments and reduce ureteral injury rate,which might be a safe,feasible and effective method.
出处
《安徽医药》
CAS
2013年第6期1007-1009,共3页
Anhui Medical and Pharmaceutical Journal
基金
马鞍山市卫生科教基金资助(No 2012-J-10)
关键词
输尿管镜
预置斑马导丝
优点
输尿管损伤高危因素
ureteroscopy
presetting zebra guidewire
advantage
high-risk factors of ureteral injure
