CAJ | 학술논문

目的：探讨输尿管狭窄2种腔内治疗方法的选择和疗效。方法2010年6月～2013年12月对46例输尿管狭窄根据术中观察狭窄的程度，结合术前静脉尿路造影（introvenous urography，IVU）和CT泌尿系成像（CT urography，CTU），选择输尿管镜直接扩张法（狭窄程度较轻者）或钬激光内切开法（狭窄程度重、狭窄长度长，或术中输尿管镜扩张困难者），术后留置输尿管支架管，1～2个月后拔除。结果46例手术均顺利完成，无输尿管撕脱、严重出血等并发症。42例临床治愈（其中输尿管镜扩张17例，钬激光内切开25例），B超显示42例肾积水均减轻，肾集合系统分离由术前（3．64±0．83）cm降至术后（1．96±0．58）cm（t＝10．111，P＝0．013）；IVU和CTU显示狭窄近段输尿管扩张减轻，由术前（16．9±1．5）mm减少为术后（9．5±1．0）mm（t ＝25．079，P＝0．000），输尿管狭窄段增宽，由术前（2．1±0．3）mm增宽到术后（5．1±0．4）mm（t ＝－37．371，P＝0．000）。结论根据输尿管狭窄不同程度和长度，以及术中操作的实际情况，合理选择镜体直接扩张法或钬激光内切开法治疗输尿管狭窄可取得良好的效果。
목적：탐토수뇨관협착2충강내치료방법적선택화료효。방법2010년6월～2013년12월대46례수뇨관협착근거술중관찰협착적정도，결합술전정맥뇨로조영（introvenous urography，IVU）화CT비뇨계성상（CT urography，CTU），선택수뇨관경직접확장법（협착정도교경자）혹화격광내절개법（협착정도중、협착장도장，혹술중수뇨관경확장곤난자），술후류치수뇨관지가관，1～2개월후발제。결과46례수술균순리완성，무수뇨관시탈、엄중출혈등병발증。42례림상치유（기중수뇨관경확장17례，화격광내절개25례），B초현시42례신적수균감경，신집합계통분리유술전（3．64±0．83）cm강지술후（1．96±0．58）cm（t＝10．111，P＝0．013）；IVU화CTU현시협착근단수뇨관확장감경，유술전（16．9±1．5）mm감소위술후（9．5±1．0）mm（t ＝25．079，P＝0．000），수뇨관협착단증관，유술전（2．1±0．3）mm증관도술후（5．1±0．4）mm（t ＝－37．371，P＝0．000）。결론근거수뇨관협착불동정도화장도，이급술중조작적실제정황，합리선택경체직접확장법혹화격광내절개법치료수뇨관협착가취득량호적효과。
Objective To investigate the selection and efficacy of endoscopic methods for the treatment of ureteral stricture . Methods Clinical data of 46 patients with ureteral stricture were analyzed retrospectively .Based on the stricture extent displayed under ureteroscope and the stricture radiography of introvenous urography or CT urography , either ureteroscopic dilation ( for mild stricture) or holmium laser endoureterotomy (for severe stricture, long stricture, or difficulty of ureteroscopic dilation ) was carried out. Results All the patients received operation successfully , and no severe complications were observed .Forty-two patients were clinically cured, including 17 patients undergoing ureteroscope dilation and 25 patients undergoing endoureterotomy .Ultrasonic examinations showed relieved hydronephrosis in these 42 patients.The separation of the renal collecting system was reduced from (3.64 ±0.83) cm to (1.96 ±0.58) cm (t=10.111, P=0.013).IVU and CTU showed the proximal dilated ureter was reduced from (16.9 ±1.5) mm preoperatively to (9.5 ±1.0) mm postoperatively (t=25.079, P=0.000).The stricture segment was dilated from (2.1 ±0.3) mm to (5.1 ±0.4) mm (t =-37.371, P=0.000).In the ureteroscopic dilation patients, 17 cases (89.5%) were cured clinically.In the endoureterotomy patients, 25 cases (92.6%) were cured. Conclusion Based on the stricture extent and the stricture length , as well as specific operational conditions , proper selection of dilation or endoureterotomy for ureteral stricture could achieve good outcomes .