输尿管镜钬激光内切开术治疗输尿管狭窄.DOCVIP

临床医学论文-输尿管镜钬激光内切开术治疗输尿管狭窄 ?????????? 作者：王亮，王庆堂，刘祥丹，邓超雄，杨 航，张秉鸿，曹文峰，陈卫国? 【摘要】? 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。方法 本组10例输尿管狭窄，狭窄位于输尿管上段6例，中段1例，下段3例，输尿管狭窄段长度为0.3-1.8cm，采用输尿管镜钬激光(200μm激光光纤，输出能量0.8-1.0J，脉冲频率10-15Hz)内切开术治疗，术后留置1根或2根F5双J支架管，2-3个月后拔管。结果 手术时间30-50min，平均42min，无严重并发症，1例手术失败，余9例随访5-15个月，平均9.5个月，8例效果满意，1例术后3个月复发。结论 输尿管镜钬激光内切开术治疗输尿管狭窄具有创伤小、并发症少、恢复快等优点，是一种安全、有效的微创手术方式。 【关键词】? 输尿管狭窄；输尿管内切开术；钬激光 ??? Treatment of ureteral strictures by holmium: YAG laser endoureterotomy ??????ABSTRACT: Objective? To determine the efficacy of ureteral strictures treated by holmium: YAG laser endoureterotomy. Methods? A total of 10 patients (5 women and 5 men, mean age 46 years) with ureteral strictures (6 in the upper, 1 in the mid, and 3 in the lower ureters) underwent holmium: YAG laser endoureterotomy using ureteroscopy and a 200microm fiber at 0.8-1 J and 10-15Hz. The length of ureteral strictures were from 0.3 to 1.8cm. Postoperatively, one or two F5 ureteral stents were remained indwelling for 2-3 months. Results? The operative duration was 30-50min (average 42min). No severe complications were observed. 1 case was unsuccessful with endoureterotomy. With a median followup of 9.5 months (ranging from 5-15 months), success was achieved in 8 of the 9 patients, and l case recrudesced 3 months after endoureterotomy. Conclusion? Holmium: YAG laser endoureterotomy is an efficient and safe treatment for ureteral strictures with less invasion, less complications and easy recovery. ??? KEY WORDS: ureteral stricture; endoureterotomy; holmium: YAG 1aser??? ??? 输尿管狭窄过去多采用开放性手术治疗。近年来，随着输尿管镜等技术的发展，人们开始尝试一些微创的治疗方法。初步观察表明，输尿管镜钬激光(Holmium：YAG激光)内切开术治疗输尿管狭窄具有创伤小、并发症少、恢复快等优点，我院2005年3月至2006年5月采用该法治疗输尿管狭窄10例，效果满意，报告如下。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 本组10例，男5例，女5例，年龄30-62岁，平均46岁。10例患者均伴不同程度患侧肾积水及腰部胀痛症状。狭窄位于左侧输尿管6例，右侧4例；位于肾盂输尿管连接部1例，输尿管上段5例，中段1例，下段3例。狭窄原因：1例为先天性输尿管狭窄，1例为结核性输尿管狭窄；8例输尿管狭窄与输尿管结石有关，其中，2例曾行输尿管切开取石术，3例曾行输尿管镜钬激光碎石术，3例输尿管结石伴输尿管狭窄及息肉。输尿管狭窄段长度为0.3-0.8cm。术前行B超、静脉尿路造影(intravenous urography, IVU)或逆行肾