CAJ | 학술논문

目的探讨与分析输尿管镜钬激光碎石术失败的原因及处理对策.方法回顾性研究本院于2012年9月～2013年10月行输尿管镜钬激光碎石术160例,使用日本Olympus 8/9.8F标准输尿管镜+美国科医人60W钬激光系统.其中手术失败11例,占6.8％.结果输尿管镜钬激光碎石术失败的原因及处理对策:①输尿管镜难以通过狭窄、扭曲输尿管腔3例,输尿管长段、严重狭窄扭曲者即使行扩张或内切开,输尿管镜也难以通过,可以留置F4.7双J管,改行开放手术或行ESWL、PCNL;②输尿管镜进镜或碎石时结石漂移,进入同侧肾盂、肾盏者3例,术中碎石或进镜时尽量保持较低灌注压力,视野清晰即可,当结石进入肾盂肾盏,可以改用输尿管软镜碎石,或留置双J管,术后予以ESWL治疗,效果较佳;③输尿管镜无法进入输尿管腔者2例,分析认为与先天性输尿管开口较小、闭锁有关,输尿管镜强力通过容易造成输尿管或膀胱损伤.老年男性前列腺中叶增生明显,后唇太高,膀胱内小梁、小室增多,以致输尿管开口难以辨认,无法进镜.术中操作时输尿管开口处黏膜损伤严重,使进镜困难;④手术操作中出现输尿管穿孔或黏膜撕脱2例,无法找到正常管腔,导致手术失败;⑤术前对阴性结石判断不足1例,导致术中找不到结石.结论严格掌握输尿管镜钬激光碎石的手术指征,熟练的手术操作技巧以及配合其他技术,能显著提高输尿管镜钬激光碎石术的成功率,减少手术失败及并发症的发生.
목적 탐토여분석수뇨관경화격광쇄석술실패적원인급처리대책.방법 회고성연구본원우2012년9월～2013년10월행수뇨관경화격광쇄석술160례,사용일본Olympus 8/9.8F표준수뇨관경+미국과의인60W화격광계통.기중수술실패11례,점6.8％.결과 수뇨관경화격광쇄석술실패적원인급처리대책:①수뇨관경난이통과협착、뉴곡수뇨관강3례,수뇨관장단、엄중협착뉴곡자즉사행확장혹내절개,수뇨관경야난이통과,가이류치F4.7쌍J관,개행개방수술혹행ESWL、PCNL;②수뇨관경진경혹쇄석시결석표이,진입동측신우、신잔자3례,술중쇄석혹진경시진량보지교저관주압력,시야청석즉가,당결석진입신우신잔,가이개용수뇨관연경쇄석,혹류치쌍J관,술후여이ESWL치료,효과교가;③수뇨관경무법진입수뇨관강자2례,분석인위여선천성수뇨관개구교소、폐쇄유관,수뇨관경강력통과용역조성수뇨관혹방광손상.노년남성전렬선중협증생명현,후진태고,방광내소량、소실증다,이치수뇨관개구난이변인,무법진경.술중조작시수뇨관개구처점막손상엄중,사진경곤난;④수술조작중출현수뇨관천공혹점막시탈2례,무법조도정상관강,도치수술실패;⑤술전대음성결석판단불족1례,도치술중조불도결석.결론 엄격장악수뇨관경화격광쇄석적수술지정,숙련적수술조작기교이급배합기타기술,능현저제고수뇨관경화격광쇄석술적성공솔,감소수술실패급병발증적발생.
Objectives To explore the causes and countermeasures of ureteroscopic holmium laser lithotripsy failure.Methods The clinical data of 11 cases of operation failed patients among 160 cases of ureteroscopic holmium laser lithotripsy in the hospital during September 2012 to October 2013 were retrospectively analyzed.Results The failed causes of ureteroscopic holmium laser lithotripsy and countermeasures:①3 cases of ureteroscopy did not pass through the narrow and twisting ureteral lumen.Countermeasures:For patients with severe stenosis ureter distortion,even undergo expansion or internal urethrotomy,ureteroscopy was also difficult to pass.It could solve by indwelling F4.7 double J tube,converted to open surgery or undergoing ESWL and PCNL.②3 cases occurred stone drift into ipsilateral renal pelvic or renal calices when ureteral mirror entering or crushing stone.Countermeasures:Try to keep low perfusion pressure when intraoperative gravel or entering mirror,keep vision clear.If the stone entering into renal pelvis,it can break stone by changed to use a flexible ureteroseopy or by indwelling double J tube,the effect of ESWL treatment after operation was better.③2 cases of ureteral mirror could not enter ureteral lumen.Countermeasures:This maybe associated with congenital ureteral atresia or smaller opening,force through of ureteroscopy was likely to cause bladder or ureter injury.④There were 2 cases of ureteral perforation or mucosal avulsion because of unable find the normal lumen.⑤1 cases of preoperative judgment errors for negative calculus,it led to the stones unable found intra-operative.Conclusions By strictly control surgical indications of urcteroscopic holmium laser lithotripsy,mastered surgical skills,and cooperate with other technology,it can significantly improve the success rate of ureteroscopic holmium laser lithotripsy and reduce the occurrence of surgery failure and complications.