输尿管口进镜失败再处理89例体会

发布时间：2018-03-20 22:55

本文选题：输尿管镜　切入点：输尿管口　出处：《中国微创外科杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的总结输尿管口进镜失败后再处理的成功经验。方法 2013年6月~2016年5月输尿管进镜失败89例,再次输尿管镜进镜,成功处理输尿管下段病变。结果 19例输尿管口狭窄中,13例直接上镜成功,4例钬激光切开进镜,2例留置双J管处理;23例输尿管壁内段走行异常形成假道中,均在假道外上方寻找到原输尿管口,进镜成功;26例输尿管口结石堵塞中,20例直接碎石后进镜成功,2例采用电切镜切开输尿管口再碎石,4例斑马导丝把结石推上去后再碎石;21例输尿管口寻找困难中,11例开口被突入膀胱的前列腺增生组织掩盖,4例开口在多发的膀胱小梁内,膀胱慢性炎症改变4例,2例异位输尿管开口,均找寻成功进镜。结论输尿管镜术中出现进镜困难在所难免,术前应对病情了解准确,熟悉输尿管的解剖结构及输尿管镜下的立体空间感,熟悉各类输尿管口进镜困难类型,有利于提高再处理成功率。
[Abstract]:Objective to summarize the successful experience of ureteroscopy after failure of ureteroscopy. Methods from June 2013 to May 2016, 89 cases of ureteroscopy failed and ureteroscopy was performed again. Results of the 19 cases of ureteral orifice stenosis, 13 cases were treated directly by endoscopy, 4 cases were treated by holmium laser incision, 2 cases were treated by double J tube, 23 cases were treated with double J tube, 23 cases formed false canal in the course of abnormal internal segment of ureter wall. The original ureteral orifice was found above the false passage. In 26 cases of obstruction of ureteral orifice stones, 20 cases were treated with direct lithotripsy and 2 cases were treated with electrosurgical incision of ureteral orifice and relithotomy of ureteral orifice. 4 cases were treated with zebra guide wire to push the stone up and 21 cases with difficulty in finding ureteral orifice. 11 cases had difficulty in finding ureteral orifice. In 4 cases, the opening was covered by protruding prostate hyperplasia tissue into the bladder, and the opening was in the multiple trabeculae of the bladder. There were 4 cases of chronic inflammation of bladder and 2 cases of ectopic ureteral orifice. It is helpful to improve the success rate of reprocessing by knowing the anatomical structure of ureter and the sense of three-dimensional space under ureteroscope and the difficult types of ureteral orifice.
【作者单位】：湘潭市中心医院泌尿外科;
【分类号】：R699.4

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