齐齐哈尔医学院学报
齊齊哈爾醫學院學報
제제합이의학원학보
JOURNAL OF QIQIHAR MEDICAL COLLEGE
2015年
2期
224-226
,共3页
经皮肾镜碎石取石术%肾盂输尿管连接部%狭窄%球囊扩张
經皮腎鏡碎石取石術%腎盂輸尿管連接部%狹窄%毬囊擴張
경피신경쇄석취석술%신우수뇨관련접부%협착%구낭확장
PCNL%Ureteroplevicjunction%Stenosis%Balloon dilatation
目的:探讨经皮肾顺行途径高压球囊扩张处理肾盂输尿管连接部狭窄的体会。方法回顾性分析了我院从2003—2013年行经皮肾镜的患者225例,术中发现肾盂输尿管连接部狭窄的患者28例,男18例,女10例,年龄24~61岁。22例患者既往有开放手术病史,6例患者有腔镜手术病史。患侧肾脏结石大小不等,均合并积水,其中肾盂积水>5 cm者5例、2~5 cm积水17例,<2 cm积水6例。术中先行PCNL术,最后根据顺行尿路造影的情况,采用顺行高压球囊予以狭窄段扩张。结果28例患者手术均顺利,无中转开放病例。其中5例因结石较复杂行双通道进行碎石取石,术中顺行造影发现肾盂输尿管连接部狭窄段均<1.5 cm,无闭锁患者,狭窄段斑马导丝均可通过,手术时间55~169 min,平均109 min。术中留置2条双“J”管23例,5例置入1条双“J”管。术后1例第4天肾脏出血,保守无效后选用选择性肾动脉栓塞治疗痊愈,所有患者均痊愈出院。手术后随访6~32个月,失访1例,肾积水明显减少23例;肾积水无明显变化2例,再狭窄2例,总治愈率为25/28(89.28%)。结论经皮肾镜术中发现肾盂输尿管连接部狭窄,拟先行处理肾结石,后根据狭窄段情况行狭窄段扩张,高压球囊扩张是安全有效的方法。
目的:探討經皮腎順行途徑高壓毬囊擴張處理腎盂輸尿管連接部狹窄的體會。方法迴顧性分析瞭我院從2003—2013年行經皮腎鏡的患者225例,術中髮現腎盂輸尿管連接部狹窄的患者28例,男18例,女10例,年齡24~61歲。22例患者既往有開放手術病史,6例患者有腔鏡手術病史。患側腎髒結石大小不等,均閤併積水,其中腎盂積水>5 cm者5例、2~5 cm積水17例,<2 cm積水6例。術中先行PCNL術,最後根據順行尿路造影的情況,採用順行高壓毬囊予以狹窄段擴張。結果28例患者手術均順利,無中轉開放病例。其中5例因結石較複雜行雙通道進行碎石取石,術中順行造影髮現腎盂輸尿管連接部狹窄段均<1.5 cm,無閉鎖患者,狹窄段斑馬導絲均可通過,手術時間55~169 min,平均109 min。術中留置2條雙“J”管23例,5例置入1條雙“J”管。術後1例第4天腎髒齣血,保守無效後選用選擇性腎動脈栓塞治療痊愈,所有患者均痊愈齣院。手術後隨訪6~32箇月,失訪1例,腎積水明顯減少23例;腎積水無明顯變化2例,再狹窄2例,總治愈率為25/28(89.28%)。結論經皮腎鏡術中髮現腎盂輸尿管連接部狹窄,擬先行處理腎結石,後根據狹窄段情況行狹窄段擴張,高壓毬囊擴張是安全有效的方法。
목적:탐토경피신순행도경고압구낭확장처리신우수뇨관련접부협착적체회。방법회고성분석료아원종2003—2013년행경피신경적환자225례,술중발현신우수뇨관련접부협착적환자28례,남18례,녀10례,년령24~61세。22례환자기왕유개방수술병사,6례환자유강경수술병사。환측신장결석대소불등,균합병적수,기중신우적수>5 cm자5례、2~5 cm적수17례,<2 cm적수6례。술중선행PCNL술,최후근거순행뇨로조영적정황,채용순행고압구낭여이협착단확장。결과28례환자수술균순리,무중전개방병례。기중5례인결석교복잡행쌍통도진행쇄석취석,술중순행조영발현신우수뇨관련접부협착단균<1.5 cm,무폐쇄환자,협착단반마도사균가통과,수술시간55~169 min,평균109 min。술중류치2조쌍“J”관23례,5례치입1조쌍“J”관。술후1례제4천신장출혈,보수무효후선용선택성신동맥전새치료전유,소유환자균전유출원。수술후수방6~32개월,실방1례,신적수명현감소23례;신적수무명현변화2례,재협착2례,총치유솔위25/28(89.28%)。결론경피신경술중발현신우수뇨관련접부협착,의선행처리신결석,후근거협착단정황행협착단확장,고압구낭확장시안전유효적방법。
Objective To study the treatment measures of ureteroplevic junction stenosis in the course of percutaneous nephrolithotomyby high pressure balloon dilatation .Methods 225 cases performed PCNL in our hospital from Jan 2003-Jan 2013 were studied , and there were 28 cases with intraoperativeureteroplevic junction stenosis, there were 18 males and 10 females with the age of 24~61 years.5 cases were with hydronephrosis of>5cm, 17 cases with hydronephrosis of 2~5cm, and 6 cases <2cm.All patients were treated with percutaneous nephrolithotomy at first , then with balloon dilatation under X-ray guideline .Results All28 cases were completed successfully , operation time was 55 ~169 minutes ( 109 minutes on average ) .1 case with postoperative renal hemorrhage was controlled with DSA homeostasis .The patients were followed up for 6 to 32 months, and 1cases were lost to follow-up.2 patients were recurred.Total cure rate was 25/28(89.28%).Conclusions To handle with ureteroplevic junction stenosis in the course of PCNL was more complex .It is safe and effective using percutaneous high pressure balloon dilatation .