输尿管镜钬激光内切开术治疗输尿管梗阻

目的 探讨输尿管镜钬激光内切开术治疗输尿管狭窄的疗效及安全性.方法 回顾性分析18例采用输尿管镜钬激光治疗的输尿管梗阻患者的临床资料.输尿管狭窄位于上段11例(其中完全闭锁4例)、中段5例、下段2例,输尿管狭窄合并结石6例,采用输尿管镜钬激光(550 μm激光光纤,输出功率35 W)内切开术治疗,术后留置矫形输尿管支架,3～6个月后拔出.结果 手术时间25～70 min,平均32 min.1例手术失败,余17例平均随访时间10.7(2～14)个月,1例因肾脏无功能继发难治性感染而行肾切除,16例肾功明显改善,患侧肾小球滤过率由术前的(16.4 ±6.9)ml/min升至(24.9±8.2)ml/min(P<0.01),随访期内未见复发.结论 输尿管镜钬激光内切开术结合矫形输尿管支架置入治疗输尿管梗阻具有创伤小、并发症少、不易复发等优点,是一种安全、有效的微创手术方式,但应进行周密的术前准备并严格掌握适应证.

Treatment of ureteral obstruction by holmium: YAG laser endoureterotomy: a report of 18 cases

Objective To investigate the clinical value and safety of holmium: YAG laser endoureterotomy in the treatment of ureteral obstruction. Methods Holmium: YAG laser endoureterotomy, with the laser optic fiber 550 μm in diameter and the output power of 3.5 Watt, via ureteroscopy, was performed on 18 patients ureteral obstruction, 8 males and 10 females, aged 52.1 (34 -67), 11 with the stricture in the upper segment (complete obstruction in 4 cases), 5 in the middle segment, and 2 in lower segment ; and 6 cases complicated with ureteral calculus. Postoperatively, an orthopedic ureteral stent ( a 6-Fr double-J ureteral stent with a movable 5 cm length 9-Fr orthopedic cannula) was remained indwelling for 3 -6 months. Follow-up was conducted for 10.7 (2-14) months. Results The operative duration was 32 (25 -70 ) minutes. One patient underwent failed endoureterntomy and was turned to percutaneous nephroscopy. Success was achieved in 16 patients. The glomerular filtration rate (GFR) of these affected kidneys increased from 16.4 ± 6.9 ml/min ante-operatively to 24.9 ± 8.2 ml/min (P<0.01) postoperatively. One kidney was resected because of non-function, with GFR of 2 ml/min and intractable pyelitis. No recurrence of ureteral stricture was observed. Conclusion Holmium: YAG laser endoureterotomy with insertion of orthopedic ureteral stent is an efficient and safe treatment for ureteral strictures with minimal invasion, less complications and easy recovery. This operation should be performed with a thorough preparation and severely restricted indication.