潘卫兵　陈雪松　金　岩　谢礼仁　张　权

[摘要] 目的:探讨输尿管镜技术在急性输尿管梗阻中临床应用的安全有效性。方法:对68例经尿道输尿管镜术(URS)诊治急性输尿管梗阻的临床资料进行回顾性研究。结果:成功解除急性梗阻66例, 有效率为97.1%。结石性梗阻58例,置双J引流管57例,取石碎石45例,1例置管碎石失败改开放手术;非结石性梗阻10例, 根据情况取活检2例, 放置双J引流管9例,1例置管失败改血液透析。结论:输尿管镜技术的急诊运用能快速、高效、安全地解除梗阻,达到保护肾功能的目的。

[关键词] 输尿管镜;输尿管梗阻;诊断;治疗

[中图分类号] R69 [文献标识码]B[文章编号]1673-7210(2009)07(a)-223-02

Treatment of ureteroscope in acute ureteral obstruction

PAN Weibing, CHEN Xuesong, JIN Yan, XIE Liren, ZHANG Quan

(Department of Urology, PingshanPeople's Hospital, Shenzhen 518118, China)

[Abstract] Objective: To evaluate the effect and safety of ureteroscoscope in the treatment of acute ureteral obstruction. Methods: Retrospectively summarize the clinical data of 68 patients with acute ureteral obstruction treated with ureteroscoscope. Results: Successfully relieved the acute obstruction in 66 cases, and cured rate was 97.1%. Obstruction caused by calculus in 58 cases, 57 caseswere treated with double J conduit enclosed, 45 cases were treated with transurethral ureteroscopic ballast lithotrity, 1 case was treated with operation after unsuccessful lithotrity. Obstruction caused by none calculus in 10 cases, 2 cases checked by biopsy, 9 casesweretreatedwith double J conduit enclosed,1 case was treatedwith hemodialysis after conduit enclosed unsuccessfully. Conclusion: The treatment of ureteroscoscope can relieve the acute obstruction fleetly, effectively, safely, and safeguard the renal function .

[Key words] Ureteroscoscope; Ureteral obstruction; Diagnosis; Treatment

2005年6月～2008年5月, 我院应用经尿道输尿管镜术(URS)诊治急性输尿管梗阻68例, 取得满意效果。现报道如下:

1 资料与方法

1.1 一般资料

本组68例中,男性44例, 女性24例;年龄17～56岁, 平均42岁。结石致双侧输尿管急性梗阻8例,其中3例伴有少尿、无尿及不同程度氮质血症;单侧梗阻50例,其中,单纯性结石致输尿管中下段梗阻42例,体外冲击波碎石术(ESWL)后“石街”形成6例,孤立肾输尿管结石梗阻2例,其中并发急性肾功能不全1例。输尿管狭窄4例,泌尿系外肿瘤2例,肾结核对侧肾积水2例,输尿管息肉、凝血块致输尿管梗阻各1例。临床表现为肾绞痛、血尿、少尿、无尿、恶心呕吐等,术前彩超、腹部平片或CT检查,明确梗阻部位,急查肾功能电解质,全面评估病情。

1.2方法

依据患者病程及积水情况选择局麻或硬膜外麻醉,其中局麻12例。德国Wolf 8.0/9.8 F 硬性输尿管镜, 液压灌注泵, Olympus 电视监视系统,气压弹道碎石系统等。……