摘要
目的探讨输尿管导引鞘在输尿管镜进镜困难时应用的可行性、有效性及安全性。方法选取2011年1月—2012年10月宁波市泌尿肾病医院泌尿外科收治的患者72例,其中输尿管结石63例,血尿或输尿管扩张行输尿管镜检查9例。采用腰硬联合麻醉或全身麻醉进行输尿管镜检查,治疗时发现输尿管狭窄、管腔狭小导致进镜困难时,用输尿管导引鞘沿斑马导丝缓慢、持续、螺旋形扩张输尿管管腔后再行输尿管镜操作。结果 72例患者中69例顺利完成输尿管镜操作;2例肾盂积水、输尿管扩张患者因输尿管黏膜苍白、管壁僵硬,扩张时输尿管抱紧感明显,为避免输尿管损伤,放置双"J"管,胃镜检查病理报告为胃腺癌;1例肾盂占位患者因输尿管僵硬,扩张失败,放弃输尿管镜活检,行患肾、输尿管全长、膀胱袖套状切除,病理报告为肾盂癌。结论输尿管导引鞘应用于输尿管镜检查、治疗时可提高输尿管狭窄、管腔狭小患者进镜成功率,从而提高输尿管镜检查、治疗的有效性、安全性,值得临床推广应用。
Objective To evaluate the feasibility, efficacy and safety of ureteral access sheath treatment when uret- eroscopy encounter difficulties. Methods 72 patients with ureteral stricture were selected from Department of Urology, Ningho Urinary and Kidney Hospital during January 2011 to Oetober 2012, of which 63 cases had ureteral stones, 9 cases had hematuria or received ureteroscopy. After combined spinal and epidural anesthesia or general anesthesia, the cases were examined by uret- eroseopy, when ureteroscopy encountered difficulties due to ureteral stricture, zebra guidewire was placed and ureteral access sheath was inserted to dilate the stricture slowly, persistently and helically before ureteroscope. Results 69 in 72 cases received ureteroscope successfully. 2 eases who had hydronephrosis and ureterectasis were found pale ureter mueosa and stiff ureter wall, urter was hugged when dilating, in order to avoid urter injury, double J stent was indwelled, gastric adenocarcinoma was con- firmed by gastroscopy and pathological examination. 1 case who had renal pelvis occupying encountered ureteroscopy failure due to stiff ureter, then ureteroscopy was given up, then sick renal, whole ureter and bladder were removed, renal pelvic carcinoma was diagnosed by pathological examination. Conclusion The application of ureteral access sheath in ureteroscopy could improve success rate when ureteroscopy encounter ureteral stricture, and enhance the efficacy and safety of ureteroscopy, it is worthy of clinical expansion application.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第36期4332-4333,共2页
Chinese General Practice
关键词
输尿管镜
输尿管梗阻
输尿管引导鞘
Urcteroscopes
Ureteral obstruction
Ureteral access sheath
