探讨电刀内切开联合球囊扩张治疗输尿管狭窄的安全性和疗效。

回顾性分析2007年5月至2016年3月我院应用电刀内切开联合球囊扩张治疗输尿管狭窄469例的临床资料，术中通过逆行、顺行或者逆行+顺行三种途径置入安全导丝后，先使用电刀内切开输尿管狭窄段全层，再使用21 F球囊扩张器扩张，留置双J管，定期复查随访评估手术效果。

469例中采用逆行途径370例，顺行途径50例，顺行+逆行途径49例。术中1例因移植肾输尿管膀胱连接部内切开大出血中转开放手术，止血成功，现长期更换支架管治疗。肾盂输尿管连接部狭窄电刀切开术后出血5例，保守治疗成功。术后1年获随访381例，275例(72.2%)一次手术治愈；106例出现狭窄复发，其中57例行2~5次腔镜下狭窄段扩张后治愈，5例改作开放手术治愈，13例改用金属网状支架植入术治愈，17例长期定期更换双J管，8例长期留置肾造瘘管，6例行患肾切除术。

电刀内切开联合球囊扩张治疗输尿管狭窄是安全、可靠、有效的，特别对于狭窄段较短、程度较轻和患肾功能较好的病例可作为首选治疗方案。

To evaluate the efficacy and safety of electrocautrey endoureterotomy combined with balloon dilation for ureteral stricture.

From May 2007 to March 2016, 469 cases of ureteral stricture were treated by electrocautrey endoureterotomy combined with balloon dilation in our hospital. The safe guide wire was put through the ureteral stricture retrogradely, anterogradely or bilaterally. The stricture was cut through transmurally by electrocautery, and was dilated ulteriorly by 21F balloon. Double J tube was indwelled. The efficaly was assessed by regular follow-up.

All 469 cases included 370 retrograde cases, 50 anterograde cases and 49 bilateral cases. One patient of renal transplantation occurred massive hemorrhage when urinary bladder junction was incised, and converted to open surgery to hemostasis. Long-term replacement stent was the treatment for this case. Five cases with ureteropelvic junction obstruction had hemorrhage, which were treated successfully by conservative treatment. 381 cases had one year follow-up, 275 cases (72.2%) had primary surgical success. Stricture recurrence occurred in 106 cases, 57 cases were cured by 2-5 times endoscopic stenosis dilation, 5 cases were converted to open surgery, 13 cases were cured by metal mesh stent implantation, 17 cases needed long-term regular replacement of double J tube, 8 patients needed long-term indwelling renal fistula, 6 cases needed nephrectomy.

Electrocautrey endoureterotomy combined with balloondilation in the treatment of ureteral stricture is safe, reliable and effective, especially for the patients with short, mild stricture and better renal function.