内镜治疗的输尿管结石患者治疗前结石位置和输尿管扩张特点分析

发布时间：2018-05-10 18:28

本文选题：输尿管 + 输尿管结石　；参考：《北京大学学报(医学版)》2017年04期

【摘要】：目的:了解输尿管镜或经皮肾镜治疗输尿管结石患者在治疗前输尿管结石的停留位置、结石所致输尿管扩张情况和不同部位输尿管结石的大小差异,为提高输尿管结石的认知水平和制定合理诊治方案提供参考依据。方法:回顾性分析2016年8月至2017年3月北京大学人民医院泌尿外科收治的129例行输尿管镜或经皮肾镜治疗的输尿管结石患者治疗前的CT影像学资料,收集肾盂输尿管连接部(ureteropelvic junction,UPJ)、近段输尿管、输尿管跨髂外血管处(ureter crossing external iliac vessel,UEIV)、远段输尿管和输尿管入膀胱处(ureterovesical junction,UVJ)各部位结石和输尿管扩张资料,分析不同部位输尿管结石和输尿管扩张特点。结果:129例输尿管结石患者中,UPJ处9例(7.0%)、近段输尿管处75例(58.0%)、UEIV处6例(4.7%)、远段输尿管26例(20.2%)、UVJ处13例(10.1%)。近段输尿管结石的平均横径为(8.47±2.36)mm、平均纵径为(11.00±4.41)mm,远段输尿管的平均横径为(6.74±1.99)mm、平均纵径为(7.50±4.28)mm,近段输尿管结石的平均横径和平均纵径均明显大于远段输尿管结石(P0.001)。114例输尿管扩张者,UPJ处的平均横径为(14.39±6.09)mm,输尿管上段的平均横径为(11.45±3.85)mm,UPJ处的平均横径明显大于输尿管上段(P0.001)。结论:输尿管结石分布于近段输尿管处最常见,停留于UEIV处的结石仅占少数,近段输尿管结石的横径和纵径大于远段输尿管结石,结石致输尿管扩张的患者中,UPJ处的扩张程度大于输尿管上段。传统观点认为输尿管结石易停留于UPJ、UEIV和UVJ这3个自然狭窄处,此观点有待重新认识。
[Abstract]:Objective: to understand the location of ureteral stones in patients with ureteral calculus treated by ureteroscopy or percutaneous nephrolithotomy, the ureteral dilatation caused by stones and the difference in the size of ureteral stones in different parts of the ureter, and to provide a reference for improving the cognitive level of ureteral calculi and making a reasonable diagnosis and treatment scheme. Method: 201 129 cases of ureteral calculi treated with ureteroscopy or percutaneous nephrolithotomy in the Department of Urology, Peking University People's Hospital from August to March 2017, 6 years, 6 years, were treated with CT imaging data of ureteropelvic junction (ureteropelvic junction, UPJ), proximal ureter, and catheter crossing the external iliac vessel (ureter crossing external iliac VE) Ssel, UEIV), distal ureteral and ureter into the bladder (ureterovesical junction, UVJ) stones and ureteral data, analysis of different parts of the ureteral stones and ureteral dilatation characteristics. Results: in 129 cases of ureteral calculi, 9 cases (7%), 75 cases (58%) of the proximal ureter, 6 cases (4.7%) in UEIV, and 26 of the distal ureter. (20.2%), 13 cases (10.1%) in UVJ. The average transverse diameter of the proximal ureteral stones was (8.47 + 2.36) mm, the average longitudinal diameter was (11 + 4.41) mm, the average transverse diameter of the distal ureter was (6.74 + 1.99) mm, the average longitudinal diameter was (7.50 + 4.28) mm. The average horizontal diameter and average longitudinal diameter of the proximal ureteral stones were significantly greater than those of the distal ureteral calculi (P0.001).114 cases. The average transverse diameter of UPJ was (14.39 + 6.09) mm, the average transverse diameter of the upper ureter was (11.45 + 3.85) mm, and the average transverse diameter at UPJ was obviously greater than that of the upper ureter (P0.001). Conclusion: ureteral stones are most common in the proximal ureter, and only a few of the stones staying at UEIV are the transverse and longitudinal diameter of the proximal ureteral stones. In patients with greater than distal ureteral stones and ureteral dilatation, the degree of dilatation at UPJ is greater than the upper ureter. Traditionally, ureteral stones are believed to remain in the 3 natural strictures of UPJ, UEIV and UVJ. This view remains to be rerecognized.

【作者单位】：北京大学人民医院泌尿外科;
【分类号】：R699

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