钬激光内切开治疗肾盂输尿管连接部再狭窄 - 第三军医大学学报.doc

钬激光内切开治疗肾盂输尿管连接部再狭窄的疗效观察 李钊 杨锦建* 贾占奎 梁宏 刘耀雷 （郑州大学第一附属医院 泌尿外科，河南 郑州 450052） 【摘要】目的：探讨输尿管镜钬激光内切开治疗肾盂输尿管连接部再狭窄的安全性和有效性。方法： 2007年3月至2010年12月期间,采用经尿道输尿管镜下钬激光内切开治疗肾盂输尿管连接部再狭窄27例，其中开放性肾盂成形术后17例，腹腔镜下肾盂成形术后10例。术中采用钬激光纵行切开狭窄段后，放置２根4 F－6 F双Ｊ管８周。术后3月复查泌尿系B超、双肾ECT。结果：术后随访6-24个月，平均14个月,24例影像学检查见肾积水减轻，治疗成功，治愈率88.9%。结论：钬激光内切开治疗肾盂输尿管连接部再狭窄安全有效，可为该类患者首选治疗方法。 【关键词】肾盂输尿管连接部再狭窄；输尿管镜术；钬激光 Retrograde ureteroscopic endotomy using holmium : YAG laser on treatment of recurrent ureteropelvic junction obstruction Li Zhao,Yang Jinjian,Jia Zhankui,Liang Hong,Liu Yaolei (Departement of urology, the First Affiliated Hospital of Zhengzhou University ,Henan,Zhengzhou450052) 【Abstract】 Objective：To evaluate the safety and efficacy of retrograde ureteroscopic Ho: YAG laser endopyelotomy for correction of recurrent ureteropelvic junction obstruction.Methods：From 2007.3- 2010.12, retrograde ureteroscopic Ho: YAG laser endopyelotomy was carried out on 27 patients of recurrent UPJ obstruction. The patients were consisted of 17 cases after open surgery pyeloplasty and 10 cases after laparoscopic pyeloplasty. The obstruction was incised with a holmium laser fiber in a linear fasion. After completing incision, two french-4 to french-6 double- J ureteral stents were left for 8 weeks. The patients were reexamined through B- ultrasound and ECT of kidney after 3 months. Result：Success was achieved in 24 cases without complication at average follow up for 14 months( 6- 24months). Conclusions: Retrograde ureteroscopic endotomy using holmium : YAG laser is a safe and minimally invasive therapy for recurrent ureteropelvic junction obstruction. This procedure could be used initially for these patients. 【Key Words】recurrent ureteropelvic junction obstructionureteroscopy ;YAG laser 　2007年3月至2010年12月我们采用经尿道输尿管镜下钬激光内切开治疗肾盂输尿管连接部再狭窄27例，效果良好，报告如下： 一、资料与方法 1、临床资料 本组27例，男15例，女12例，年龄7-42岁，平均28岁。左侧16例，右侧11例。开放性肾盂成形术后17例，腹腔镜下肾盂成形术后10例。狭窄段长度4-24 mm，平均13 mm。肾集合系统分离16-43mm，平均33 mm。肾动态检查见患肾肾小球率过滤15.6-72.1 ml/