腹腔镜和输尿管镜联合治疗15例医源性输尿管狭窄

Laparoscopy and ureteroscopy combined treatment of 15 cases of iatrogenic ureteral stricture

摘要:

目的 探讨联合镜种技术（腹腔镜+输尿管镜）治疗医源性输尿管狭窄的安全性、可行性和有效性。方法 回顾性分析2018年1月－2020年12月在娄底市中心医院用联合镜种技术（腹腔镜+输尿管镜）治疗的15例医源性输尿管狭窄患者的临床资料。其中，男8例，女7例；年龄31~65岁，平均（38.50±7.10）岁；术前病变侧肾脏积水：轻度4例、中度9例、重度2例；肾功能：肌酐（120.33±16.52）μmol/L、尿素氮（13.22±2.12）mmol/L；狭窄段长度0.5～2.5 cm，平均为（1.32±0.30）cm；狭窄部位：上段3例、中段7例、下段5例。结果 15例患者均顺利行腹腔镜联合输尿管镜输尿管狭窄段切除端端吻合术。手术时间（190.64±25.33）min，术后尿管拔除时间（14.50±0.72）d，术后下床活动时间（1.54±0.32）d，术后胃肠功能恢复时间（1.81±0.54）d，手术失血量（119.74±48.22）mL，术后出院时间（7.22±0.80）d（双J管未拔除），双J管拔除时间（70.51±8.11）d。术后随访7~19个月，平均（12.70±5.34）个月，患者病变侧症状消失、肾积水及肾功能改善，无再发输尿管狭窄。结论 联合镜种技术（腹腔镜+输尿管镜）治疗医源性输尿管狭窄是安全、可行及有效的；能快速准确地定位狭窄段并完整切除狭窄段，是医源性输尿管狭窄治疗手段的一个重要补充。

Abstract:

Objective To explore the safety, feasibility and effectiveness of (laparoscopy + ureteroscopy) combined endoscopic techniques in the treatment of iatrogenic ureteral stenosis.Methods A retrospective analysis of the clinical data of 15 patients with iatrogenic ureteral stenosis treated with (laparoscopic + ureteroscopy) combined endoscopic techniques from January 2018 to December 2020. 8 males and 7 females; age 31~65 years, average (38.50 ± 7.10) years old, preoperative hydronephrosis on the affected side: 4 cases of mild, 9 cases of moderate, 2 cases of severe; renal function: Creatinine (120.33 ± 16.52) μmol/L, Urea Nitrogen (13.22 ± 2.12) mmol/L. The length of the stenosis was 0.5 ~ 2.5 cm, with an average of (1.32 ± 0.30) cm; the stenosis: 3 cases in the upper part, 7 cases in the middle part, and 5 cases in the lower part.Results All the 15 patients underwent smooth end-to-end anastomosis (laparoscopic + ureteroscopy) combined with endoscopic resection of ureteral stricture. Operation completion time (190.64 ± 25.33) min, postoperative catheter removal time (14.50 ± 0.72) d, postoperative time to get out of bed (1.54 ± 0.32) d, postoperative bowel function recovery time (1.81 ± 0.54) d, the blood loss was (119.74 ± 48.22) mL, the postoperative discharge time was (7.22 ± 0.80) d (the double J tube was not removed), and the double J tube was removed (70.51 ± 8.11) d. After 7 ~ 19 (12.70 ± 5.34) months of follow-up, the symptoms of the diseased side disappeared, hydronephrosis and renal function improved, and no ureteral stenosis recurred.Conclusion (Laparoscopy + ureteroscopy) combined endoscopic technique in the treatment of iatrogenic ureteral stenosis is safe, feasible and effective; it can quickly and accurately locate the stenosis and completely remove the stenosis, which is an important supplement to the treatment of iatrogenic ureteral stenosis.