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目的:探讨经尿道输尿管镜检联合钬激光在治疗医源性下段输尿管损伤中的临床疗效。方法:回顾性分析2009年10月～2012年5月期间采用经尿道输尿管镜检联合钬激光治疗9例医源性下段输尿管损伤患者临床资料:女8例,男1例,平均年龄48.6岁;左侧7例,右侧2例;子宫全切除致损伤5例,直肠癌根治术致伤3例,子宫复发性肿瘤根治术所致1例。经尿道输尿管导管(F3/F5)或斑马导丝引导下缓慢镜检,仔细辨认瘘口进入输尿管近端;若输尿管缝扎闭锁,予以钬激光击碎黏膜下缝线并取出,留置F7或F8双J管。2～3个月后拔除,定期随访。结果:1例患者经尿道输尿管镜下顺利置入双J管引流后治愈;6例患者经尿道输尿管镜下联合钬激光治疗后置入双J管引流,漏尿分别于术后1～7天停止;2例输尿管完全离断患者输尿管镜下置管失败改行输尿管膀胱再植术治愈。手术成功患者留置双J管于术后2～3个月拔除。术后随访6～12个月,静脉肾盂造影(IVU)检查证实患侧尿路连续性恢复,输尿管通畅,肾输尿管积水明显减轻或正常。结论:经尿道输尿管镜检联合钬激光治疗并置入双J管内引流是治疗医源性输尿管损伤(尤其是输尿管误扎后)的有效方法,具有疗效可靠、创伤小、患者易于接受等优点。与传统的行修补或输尿管膀胱再植术相比,术前行输尿管镜检没有增加患者痛苦及并发症,即使微创治疗失败,也为开放手术明确病变位置提供了帮助。
Objective: To investigate the clinical efficacy of transurethral ureteroscopic holmium laser in the treatment of iatrogenic lower ureteral injury. Methods: The clinical data of 9 patients with iatrogenic inferior ureteral injury treated by transurethral ureteroscopy combined with holmium laser during the period from October 2009 to May 2012 were retrospectively analyzed. There were 8 males and 1 females, with an average age of 48.6 years. 7 cases on the left side and 2 cases on the right side. Five cases were caused by hysterectomy, three cases were caused by radical resection of rectal cancer, and one case was caused by radical resection of uterine tumor. Transurethral ureteral catheter (F3 / F5) or zebra guide wire under the guidance of slow microscopy, carefully identify the fistula into the proximal ureter; if ureteral suture closure, holmium laser smash the submucosal suture and removed, leaving F7 or F8 Double J tube. 2 to 3 months after removal, regular follow-up. Results: One patient underwent transurethral ureteroscopic placement of double J-tube drainage and cured. Six patients underwent transurethral ureteroscopic holmium laser treatment and double J-tube drainage. Urine leakage was observed in 1 to 7 days after operation Stop; 2 cases of complete ureteral transection ureteroscopic catheter failed to divert ureter bladder replantation cure. Successful operation of patients with double J tube in 2 to 3 months after removal. All cases were followed up for 6 to 12 months. Intravenous pyelography (IVU) confirmed the recovery of ipsilateral urinary tract continuity, ureteral patency, renal hydronephrosis significantly reduced or normal. Conclusions: Transurethral ureteroscopy combined with holmium laser and double J-tube drainage is an effective method for the treatment of iatrogenic ureteral injury (especially after ureteral obstruction), which has the advantages of reliable curative effect, less trauma and easier patient acceptance. Compared with the conventional repair or ureter bladder replantation, preoperative ureteroscopy did not increase the patient’s pain and complications, even if minimally invasive treatment fails, but also open surgery to clarify the location of the lesion has helped.