CAJ | 학술논문

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及安全性.方法回顾性分析18例采用输尿管镜钬激光治疗的输尿管梗阻患者的临床资料.输尿管狭窄位于上段11例(其中完全闭锁4例)、中段5例、下段2例,输尿管狭窄合并结石6例,采用输尿管镜钬激光(550 μm激光光纤,输出功率35 W)内切开术治疗,术后留置矫形输尿管支架,3～6个月后拔出.结果手术时间25～70 min,平均32 min.1例手术失败,余17例平均随访时间10.7(2～14)个月,1例因肾脏无功能继发难治性感染而行肾切除,16例肾功明显改善,患侧肾小球滤过率由术前的(16.4 ±6.9)ml/min升至(24.9±8.2)ml/min(P<0.01),随访期内未见复发.结论输尿管镜钬激光内切开术结合矫形输尿管支架置入治疗输尿管梗阻具有创伤小、并发症少、不易复发等优点,是一种安全、有效的微创手术方式,但应进行周密的术前准备并严格掌握适应证.
목적 탐토수뇨관경화격광내절개술치료수뇨관협착적료효급안전성.방법 회고성분석18례채용수뇨관경화격광치료적수뇨관경조환자적림상자료.수뇨관협착위우상단11례(기중완전폐쇄4례)、중단5례、하단2례,수뇨관협착합병결석6례,채용수뇨관경화격광(550 μm격광광섬,수출공솔35 W)내절개술치료,술후류치교형수뇨관지가,3～6개월후발출.결과 수술시간25～70 min,평균32 min.1례수술실패,여17례평균수방시간10.7(2～14)개월,1례인신장무공능계발난치성감염이행신절제,16례신공명현개선,환측신소구려과솔유술전적(16.4 ±6.9)ml/min승지(24.9±8.2)ml/min(P<0.01),수방기내미견복발.결론 수뇨관경화격광내절개술결합교형수뇨관지가치입치료수뇨관경조구유창상소、병발증소、불역복발등우점,시일충안전、유효적미창수술방식,단응진행주밀적술전준비병엄격장악괄응증.
Objective To investigate the clinical value and safety of holmium: YAG laser endoureterotomy in the treatment of ureteral obstruction. Methods Holmium: YAG laser endoureterotomy, with the laser optic fiber 550 μm in diameter and the output power of 3.5 Watt, via ureteroscopy, was performed on 18 patients ureteral obstruction, 8 males and 10 females, aged 52.1 (34 -67), 11 with the stricture in the upper segment (complete obstruction in 4 cases), 5 in the middle segment, and 2 in lower segment ; and 6 cases complicated with ureteral calculus. Postoperatively, an orthopedic ureteral stent ( a 6-Fr double-J ureteral stent with a movable 5 cm length 9-Fr orthopedic cannula) was remained indwelling for 3 -6 months. Follow-up was conducted for 10.7 (2-14) months. Results The operative duration was 32 (25 -70 ) minutes. One patient underwent failed endoureterntomy and was turned to percutaneous nephroscopy. Success was achieved in 16 patients. The glomerular filtration rate (GFR) of these affected kidneys increased from 16.4 ± 6.9 ml/min ante-operatively to 24.9 ± 8.2 ml/min (P<0.01) postoperatively. One kidney was resected because of non-function, with GFR of 2 ml/min and intractable pyelitis. No recurrence of ureteral stricture was observed. Conclusion Holmium: YAG laser endoureterotomy with insertion of orthopedic ureteral stent is an efficient and safe treatment for ureteral strictures with minimal invasion, less complications and easy recovery. This operation should be performed with a thorough preparation and severely restricted indication.