双J管在腹腔镜泌尿外科手术中的应用.DOCVIP

临床医学论文-双J管在腹腔镜泌尿外科手术中的应用 ?????????? 作者：阴雷，徐丹枫,任吉忠，姚亚成，刘玉衫，高轶，崔心刚，郑宏征 【摘要】? 目的：探讨双J管在泌尿外科腹腔镜手术中的应用方法、作用、效果、常见并发症及处理措施。方法：为70例上尿路梗阻性疾病患者用腹腔镜手术治疗，术中留置双J管2～8周。结果：70例患者术后切口愈合良好,无切口感染及漏尿发生，随访3～12个月，患侧肾积水及肾功能明显改善。结论：腹腔镜治疗上尿路梗阻性疾病应用双J管效果明显，置管操作需要一定的技巧，常见并发症与开放手术相似，通过对症处理可缓解。 【关键词】? 上尿路梗阻；双J管；输尿管支架；腹腔镜术 ??? 【Abstract】? Ｏbjective:To explore the effectiveness,method,complications and measures to deal with complications of indwelling of doubleJ ureteral stent in treatment of upper urinary obstruction by laparoscopic? operation.Methods:Seventy cases were employed in this study,including laparoscopic ureterolithotomy(49),laparoscopic pyeloplasty(18),laparoscopic ureteroplasty (3),and one doubleJ stent was reserved for all cases in the operation.The lasting time of doubleJ indewell ranged from 2 to 8 weeks.Results:No complications such as wound infection,leakage of urine occurred after operation.Ultrasound B and IVU investigation showed that hydronephrosis reduced and renal function improved in all cases during 3 to 12 months of followup.Conclusions:Application of doubleJ stent? in treatment of upper urinary obstruction by laparoscopic operation is valid,and the technique of indwelling of doubleJ ureteral stent is important.The complications of indwelling of doubleJ ureteral stent by laparoscopic surgery are similar to open surgery and can be relieved by adequate procedure. ??? 【Key words】? Upper urinary obstruction；DoubleJ stent；Ureteral stent；Laparoscopy ??? 双J管在泌尿系统疾病诊断、治疗中的作用已在开放手术中得到证实。随着泌尿外科腹腔镜手术技术的发展，目前大部分上尿路梗阻性疾病开始施行微创手术，双J管在腹腔镜术中的应用也越来越广泛。2002年6月至2007年5月我们用腹腔镜治疗上尿路梗阻性疾病共70例，术中常规留置双J管作为内支架引流,效果满意，现将置管操作体会、常见并发症及其处理措施报道如下。 ??? 1? 资料与方法 ??? 1.1? 临床资料? 本组70例中男42例,女28例,21～65岁,平均38.6岁。其中输尿管结石49例,肾盂输尿管连接部狭窄（ureteropelvic junction obstruction,UPJO）18例,输尿管膀胱连接部狭窄3例。所有患者均经静脉尿路造影(intravenousurogarphy,IVU)、磁共振尿路造影（magnetic resonance urography,MRU）等检查明确诊断，30例行患侧逆行造影检查了解梗阻段以下尿路通畅情况。 ??? 1.2? 手术方法? 术中根据输尿管切口距膀胱的长度，用2段F４输尿管导管沿相邻两侧孔分别插入双J管两端作支撑。开始置管时，经Trocar将双J管带输尿管导管长端放入手术野，尾端留于