筋膜扩张器在输尿管镜治疗输尿管下段结石中的应用

doi:10.3877/cma.j.issn.1674-3253.2017.01.010

中华腔镜泌尿外科杂志(电子版) ›› 2017, Vol. 11 ›› Issue (01) : 42 -45. doi: 10.3877/cma.j.issn.1674-3253.2017.01.010

所属专题：文献；

临床研究

筋膜扩张器在输尿管镜治疗输尿管下段结石中的应用

肖克兵¹, 尹传民¹^,^†(

), 那永刚¹

^1. 710077　西安医学院第一附属医院泌尿外科

收稿日期:2016-03-29 出版日期:2017-02-01
通信作者: 尹传民

Clinical application of fascia dilator in ureteroscope for treatmengt of lower ureteral stones when undergo ureteroscopy

Kebing Xiao¹, Chuanmin Yin¹^,^†(), Yonggang Na¹

^1. Department of Urology, the First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China

Received:2016-03-29 Published:2017-02-01
Corresponding author: Chuanmin Yin
About author:
Corresponding author: Yin chuanmin, Email: 86681148@qq.com

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目的

探讨肾筋膜扩张器在经尿道输尿管镜手术中的应用价值。

方法

回顾性分析西安医学院第一附属医院泌尿外科自2014年1月至2015年12月收治的50例输尿管下段结石患者，在斑马导丝引导下输尿管镜直视下以8 F筋膜扩张器扩张输尿管壁间段，扩张后行输尿管镜下气压弹道碎石术。

结果

50例结石均一期碎石成功，手术时间（40±9）min。其中男性22例，8例筋膜扩张器扩张输尿管壁间段失败，成功率14/22（63.6%）。女性28例，成功率28/28（100%）。术中未发生输尿管穿孔、假道，输尿管黏膜剥脱、断裂等并发症。术后4例女性、1例男性患者出现发热，予敏感抗生素抗感染治疗后痊愈。术后导尿管留置时间（1.6±0.7）d，双J管留置时间（11±4）d。随访半年未见输尿管狭窄及肾积水加重。

结论

经尿道输尿管镜手术中使用肾筋膜扩张器扩张输尿管壁间段有利于输尿管镜进入，减少输尿管术中损伤，女性成功率高，尤其适合于女性患者。

关键词: 输尿管结石, 输尿管镜, 筋膜扩张器

Objective

To explore the clinical value of renal fascia dilator in ureteroscopy.

Methods

Dilation of ureter was taken by 8 F fascia dilator in 50 patients who were diagnosed as lower ureteral calculi and underwent ureteroscopic pneumatic lithotripsy in the First Affiliated Hospital of Xi'an Medical University from January 2014 to December 2015. The data were analyzed retrospectively.

Results

All 50 patients were stone-free after the first procedure. Operation time was (40±9) min. Eight men failed when expanded intramural ureter with fascia dilator. The success rate was 14/22 (63.6%). But the success rate was 28/28(100%) in 28 women. No severe complications such as ureteral perforation, false passage, avulsion of the ureter、ureter fracture were occurred. Five patients had fever who were treated with sensitive antibiotic. The catheters were removed (1.6±0.7) days postoperatively. Double J stent were removed on (11±4) days. No ureteral stricture and hydronephrosis were found during 6 monthes follow up.

Conclusion

Fascia dilator can make the entry of ureteroscope easy, can reduce the complications of ureteroscopic pneumatic lithotripsy. Female’s success rate was higher, so this method is especially suitable for the female patients.

Key words: Ureteral calculi, Ureteroscopy, Fascia dilator

图3 扩张后的输尿管口明显变大易于进镜

[1]	那彦群等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社, 2013.
[2]	D'addessi A, Bassi P. Ureterorenoscopy: avoiding and managing the complications[J]. Urol Int, 2011, 87(3): 251-259.
[3]	Tanriverdi O, Silay MS, Kadihasanoglu M, et al. Revisiting the predictive factors for intra-operative complications of rigid ureteroscopy: a 15-year experience[J]. J Urol, 2012, 9(2): 457-464.
[4]	万旭辉，赖建平，陈善勤，等.输尿管镜气压弹道碎石术治疗输尿管结石(附2620例报告)[J].中国内镜杂志, 2012, 18(2): 180-183.
[5]	潘家强，覃展偶，龚明军.输尿管镜手术入镜困难的原因分析及处理技巧探讨[J].临床外科杂志, 2011, 19(10): 691-693.
[6]	Sugihara T, Yasunaga H, Horiguchi H, et al. A nomogram predicting severe adverse events after ureteroscopic lithotripsy: 12 ?372 patients in a Japanese National series[J]. BJU Int, 2013, 111(3): 459-466.
[7]	Ozsoy M, Acar O, Sarica K, et al. Impact of gender on success and complication rates after ureteroscopy[J]. World J Urol, 2015, 33(9): 1297-1302.
[8]	朱再生，刘全启，陈良佑，等.输尿管镜钬激光碎石术治疗输尿管结石(附677例报告)[J].中国微创外科杂志, 2014, 20(1): 46-49.
[9]	Hohenfellner M, Santucci RA.泌尿外科急症[M].北京:人民卫生出版社, 2010.
[10]	刘山，刘文彬，刘鸿燕，等.输尿管扩张器在局麻下经尿道输尿管镜下碎石中的应用[J/CD].中华腔镜泌尿外科杂志:电子版, 2013, 7(1): 63-65.
[11]	王竞，杨玉恺，陆鲲，等.筋膜扩张器配合输尿管镜钬激光在女性中下段输尿管结石中的临床应用价值(附56例报告)[J].临床泌尿外科杂志, 2015, 30(12): 1105-1106.
[12]	李林，刘应清，刘卫平，等.筋膜扩张器在治疗女性输尿管下段嵌顿性结石中的应用[J].国际泌尿系统杂志, 2014, 34(6): 834-836.
[13]	姜卫东，张青汉，叶绪龙，等.输尿管镜配合肾筋膜扩张器的临床应用[J].临床泌尿外科杂志, 2009, 24(6): 458-459.
[14]	刘晋峰，姚永军，王云恩，等.肾筋膜扩张器扩张治疗放疗所致的输尿管壁段狭窄15例报告[J].中华泌尿外科杂志, 2011, 32(10): 714.
[15]	徐亚文，刘春晓，郑少波，等.筋膜扩张器在处理男性前尿道和女性输尿管下段狭窄中的应用[J].中华泌尿外科杂志, 2007, 28(5): 321.
[16]	庄红雨，彭涛，许学敏.输尿管镜气压弹道碎石术治疗输尿管结石（附1180例报告）[J].中国微创外科杂志, 2014, 14(5): 426-429.

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Clinical application of fascia dilator in ureteroscope for treatmengt of lower ureteral stones when undergo ureteroscopy

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Clinical application of fascia dilator in ureteroscope for treatmengt of lower ureteral stones when undergo ureteroscopy