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电切加球囊扩张术治疗输尿管狭窄的疗效分析

Efficacy analysis of transurethral resection and ball pouch dilatation for treatment of ureterostenosis

摘要:

目的 探讨输尿管镜下电切加球囊扩张术治疗输尿管狭窄的临床疗效. 方法 回顾性分析2008年6月至2011年6月收治的49例输尿管狭窄患者的临床资料,其中,男20例,女29例,年龄15 ~56岁,平均40岁.患侧肾功能轻度受损者4例,中度受损者35例,重度受损者10例.肾盂输尿管连接处狭窄11例.输尿管上段狭窄13例,中下段狭窄25例.狭窄段长度0.3~2.0 cm,平均为1.2 cm.其中经皮肾微穿刺输尿管镜下电切加球囊扩张术治疗17例,经尿道输尿管镜下完成31例.双J管留置3~6个月,45例患者获随访,随访时间12~43个月,平均24个月.结果 48例手术顺利完成,1例中转开放行肾盂输尿管连接部成形术.手术时间25~95 min,平均42 min;术后住院时间2-6d,平均4d.45例随访复查B超及CT示肾积水明显减轻39例,IVU示输尿管显影通畅无明显狭窄;肾积水无明显变化6例. 结论 输尿管镜直视下电切结合球囊扩张治疗输管狭窄手术效果确切、痛苦小、术后恢复快、住院时间短,为输尿管狭窄患者提供新的有效治疗方法.

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abstracts:

Objective To investigate the efficacy of transurethral resection and ball pouch dilatation for treatment of ureterostenosis. Methods The clinical data of 49 cases of ureteral stricture were analyzed retrospective analysis from June 2008 to June 2011 with 20 cases of male patients and 29 cases of female patients.The age was 15 to 56 years,with a mean age of 40 years.Ipsilateral renal function were mild impairment in 4 cases,moderate impairment in 35 cases,and severe damage in 10 cases.There were ureteropelvic junction etenosis in 11 cases,upper ureteral stricture in 13 cases,and lower segment stenosis in 25 cases.The ureteral stricture length was 0.3 to 2.0 cm,with a mean of 1.2 cm.Seventeen patients were treated with transurethral resection and ball pouch dilatation by minimally invasive percutaneous nephrostomy,and 31 cases were completed by ureteroscopy.The ureteral stents were removed by ureteroscope after 3 - 6 months.45 cases were followed up for 12 -43 months,with a mean of 24 months. Results Forty-eight cases were completed smoothly with 1 case converted to open surgery.The surgical time was 25 to 95 min with a mean of 42 min.The postoperative hospital stay was 2 to 6 d with a mean of 4 d.In the follow-up of 45 cases,B ultrasound and CT scan showed hydronephrosis reduced significantly in 39 patients,IVU showed unobstructed ureter without significant stenosis.And 6 cases showed no significant changes in hydronephrosis. Conc(t)usion The method of transurethral resection and ball pouch dilatation has good clinical effect,less pain and shorter hospital stays,which provides a new and effective treatment for patients with ureteral stricture.

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