电切镜联合输尿管镜在腺性膀胱炎中寻找困难输尿管开口的应用

发布时间：2019-01-09 19:08

【摘要】：目的探讨电切镜联合输尿管镜在腺性膀胱炎中寻找困难输尿管开口的方法,提高内镜下置入双J管的成功率。方法回顾性分析2015年3月-2016年5月,8例腺性膀胱炎合并有困难输尿管开口的患者的临床资料。均为男性患者,年龄38~64岁,平均44.3岁。电切膀胱内病变,切除深度为黏膜下层和肌层,将输尿管开口区域的坏死组织切除干净,切除深度能够显露肌层的纹理改变。进一步切除肌肉组织,透过薄层肌肉组织能够看见尿液。在导丝引导下置入输尿管镜,镜下观察证实为输尿管管腔。在导丝引导下留置双J管一根。结果 8例患者(16侧)均应用电切镜联合输尿管镜成功置入双J管。手术时间35~205 min,平均时间83.2 min,术中失血量约20~50 ml。术后3~5天拔除尿管。术后1或2天复查腹部平片,显示双侧双J管位置良好,没有出现异位、扭曲等现象。围手术期未出现并发症。结论应用电切镜联合输尿管镜在腺性膀胱炎中寻找困难输尿管开口,能够提高寻找输尿管开口成功的概率,此方法安全、创伤小、避免开放手术。
[Abstract]:Objective to explore the method of finding difficult ureteral orifice in cystitis glandularis by electroresection combined with ureteroscope, and to improve the success rate of double J tube placement under endoscope. Methods the clinical data of 8 patients with cystitis glandularis complicated with difficult ureteral orifice from March 2015 to May 2016 were retrospectively analyzed. All patients were male, aged 38 to 64 years (mean 44.3 years). The depth of resection was submucosa and muscular layer. The necrotic tissue in the area of ureteral orifice was excised. The depth of resection could reveal the texture of myometrium. Further excision of muscle tissue, through the thin layer of muscle tissue can see urine. The ureteroscope was placed under the guidance of the guide wire, and the ureteral cavity was confirmed by the observation under the microscope. A double J tube is retained under the guide of the guide wire. Results 8 cases (16 sides) were successfully implanted with double J tube by electroresection combined with ureteroscope. Mean time of operation: 35 ~ 205 min,: 83. 2 min,. Blood loss during operation is about 20 to 50 ml. Urinary catheter was removed 3 days after operation. 1 or 2 days after operation, the abdominal plain film showed that the bilateral J tubes were well located, no ectopia, distortion and so on. There were no complications during the perioperative period. Conclusion finding the difficult ureteral orifice in cystitis glandularis with electroresection combined with ureteroscope can increase the probability of success in finding ureteral orifice. This method is safe, less traumatic and avoids open operation.
【作者单位】：河北医科大学第二医院泌尿外科;
【基金】：河北医科大学第二医院科学研究基金项目(No:2h1201623)
【分类号】：R694.3

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