经皮途径高压球囊扩张治疗术中肾盂输尿管连接部狭窄的体会

摘要

Objective To study the treatment measures of ureteroplevic junction stenosis in the course of percutaneous nephrolithotomyby high pressure balloon dilatation .Methods 225 cases performed PCNL in our hospital from Jan 2003-Jan 2013 were studied , and there were 28 cases with intraoperativeureteroplevic junction stenosis, there were 18 males and 10 females with the age of 24~61 years.5 cases were with hydronephrosis of>5cm, 17 cases with hydronephrosis of 2~5cm, and 6 cases <2cm.All patients were treated with percutaneous nephrolithotomy at first , then with balloon dilatation under X-ray guideline .Results All28 cases were completed successfully , operation time was 55 ~169 minutes ( 109 minutes on average ) .1 case with postoperative renal hemorrhage was controlled with DSA homeostasis .The patients were followed up for 6 to 32 months, and 1cases were lost to follow-up.2 patients were recurred.Total cure rate was 25/28(89.28%).Conclusions To handle with ureteroplevic junction stenosis in the course of PCNL was more complex .It is safe and effective using percutaneous high pressure balloon dilatation .%目的：探讨经皮肾顺行途径高压球囊扩张处理肾盂输尿管连接部狭窄的体会。方法回顾性分析了我院从2003—2013年行经皮肾镜的患者225例，术中发现肾盂输尿管连接部狭窄的患者28例，男18例，女10例，年龄24～61岁。22例患者既往有开放手术病史，6例患者有腔镜手术病史。患侧肾脏结石大小不等，均合并积水，其中肾盂积水＞5 cm者5例、2～5 cm积水17例，＜2 cm积水6例。术中先行PCNL术，最后根据顺行尿路造影的情况，采用顺行高压球囊予以狭窄段扩张。结果28例患者手术均顺利，无中转开放病例。其中5例因结石较复杂行双通道进行碎石取石，术中顺行造影发现肾盂输尿管连接部狭窄段均＜1．5 cm，无闭锁患者，狭窄段斑马导丝均可通过，手术时间55～169 min，平均109 min。术中留置2条双“J”管23例，5例置入1条双“J”管。术后1例第4天肾脏出血，保守无效后选用选择性肾动脉栓塞治疗痊愈，所有患者均痊愈出院。手术后随访6～32个月，失访1例，肾积水明显减少23例；肾积水无明显变化2例，再狭窄2例，总治愈率为25／28（89．28％）。结论经皮肾镜术中发现肾盂输尿管连接部狭窄，拟先行处理肾结石，后根据狭窄段情况行狭窄段扩张，高压球囊扩张是安全有效的方法。