经尿道输尿管镜技术在泌尿外科的应用(附1100例报告)

目的探讨输尿管镜技术在泌尿外科疾病诊治中的临床应用价值。方法2003年1月至2005年6月应用经尿道输尿管镜技术诊断和治疗泌尿系疾病患者1100例。其中行输尿管镜治疗者1010例，包括输尿管结石945例1000侧，其中上段结石68例侧、中段360例370侧、下段517例562侧；输尿管狭窄20例侧；医原性双J管滞留28例；小儿后尿道狭窄2例、后尿道瓣膜症2例、下尿路结石3例、小儿逆行输尿管插管8例侧、内支架管置入2例侧。用于泌尿系疾病诊断90例侧。结果输尿管下段结石取石成功率为97．3％（547／562）；中段为93．0％（344／370）；上段为73．5％（50／68）。输尿管狭窄及小儿后尿道狭窄扩张、小儿后尿道瓣膜症等疾病疗效满意。用于诊断的90例患者中，发现肿瘤8例、阴性结石40例、息肉12例、腺性输尿管炎4例、输尿管狭窄12例、无阳性发现13例。手术失败12例。发生严重手术并发症30例，发生率2．7％（30／1100），其中输尿管高位横断拖出2例、穿孔10例、假道12例、黏膜撕脱3例、严重出血3例。结论只要熟练掌握，输尿管镜技术的并发症发生率较低，对输尿管下段结石可作为首选治疗措施，对其他疾病尤其是小儿患者有独特优势。

Significance of ureteroscopy in manipulation of urological diseases (report of 1100 cases)

Objective To evaluate the value of ureteroscopy in the diagnosis and treatment of u-rological diseases. Methods A retrospective analysis was made on the clinical data of 1100 cases from January 2003 to 2005 in our Department. Ureteroscopy was applied to treat 1010 cases which included ureteral stones in 945 cases (1000 sides) (68 cases 68 sides in upper, 360 cases 370 sides in middle, 517 cases 562 sides in lower), ureteral strictures in 20, ureteral double J catheter stagnation in 28 and 17 children (which was lower urinary stones in 3, urethral strictures in 2, urethral valva in 2 and retrograde ureteral stent installment in 10). Ureteroscopy was also applied to diagnosis in 90 cases. Results In 945 ureteral stone cases (1000 sides), the successful rate was 97. 3% (547/562), 93. 0%(344/370) and 73. 5%(50/68) in lower, middle and upper. The satisfactory results were obtained in ureteral strictures, children urethral strictures, children urethral valva and so on. Among the diagnoses in 90 cases, there were 76 cases found abnormality including tumor in 8 cases, stone in 40, polyps in 12, strictures in 12 and glandularis ureteritis in 4. Twelve cases were not succeeded. The overall complication rate was 2. 7%(30/1100), including ureteral transect in upper in 2, perforation in 10, by way in 12, worry of mucous membrane in 3 and grave bleeding in 3. Conclusions Ureteroscopy coud be the first choice to treat lower ureteral stone, and it also has an advantage in the diagnosis and treatment of other ureteropathy, especially in children.