输尿管镜进镜技巧及意外情况处理策略

摘要

目的：：探讨进行输尿管镜手术时的进镜技巧及意外情况处理策略。方法：回顾性分析956例输尿管镜下钬激光碎石治疗输尿管结石患者临床资料。结果：发生进镜困难、上镜困难103例，包括输尿管狭窄56例，其中输尿管开口狭窄16例，输尿管轻度狭窄26例，输尿管狭窄段5例，输尿管狭窄环9例；输尿管扭曲35例；输尿管开口处结石完全堵塞4例；男性膀胱炎(盆腔脂肪增多症)未找到输尿管开口2例；肾盂输尿管处近似闭锁2例；前列腺增生伴较多前列腺组织突入膀胱2例；输尿管镜下放置双 J 管穿破肾盂1例；输尿管穿孔后放置双 J 管失败后改为开放手术1例。结论：输尿管镜进镜过程中遇到的困难多为输尿管狭窄、扭曲等，经导管引导扩张、加大水压、变换体位、更换细输尿管镜及改变输尿管镜进镜角度多能置镜成功。果断改为开放手术是补救输尿管镜操作失误的有效措施。%Objective:To explore the management skills of ureteroscope and handling the accidents strategy. Methods:The clinical data of 956 patients with ureteral calculi treated with Holmium laser lithotripsy under ureteroscope were retrospectively analyzed. Results:The ureteroscope operations in 103 cases were difficulty,which included 56 cases with ureterostenosis(including the ureter opening stricture in 16 cases,mild ureteral stenosis in 26 cases,segment ureteral stricture in 5 cases and ureteral stricture ring in 9 cases),35 cases with ureter twist,4 cases with the opening blocked by ureter stone,2 cases with no ureter opening because of cystitis (pelvic lipomatosis),2 cases with ureteropelvic atresia,2 cases with prostatic hyperplasia complicated with more prostate tissue breaking into the bladder,1 case with renal pelvis perforation caused by placing double J tube and 1 case with open surgery because of the placing double J tube failure. Conclusions:The ureteral stenosis and distortion are usually problems in ureteroscope operation,which can be settled by guiding catheter dilatation,increasing water pressure,changing position,replacing fine ureteroscope and exchanging the angle of ureteroscope. open surgery is the effective measure to correct error.