摘要目的 探讨输尿管镜术中应对输尿管缩窄、扭曲、痉挛,或黏膜游离度大等复杂状况的有效方法.方法 2005-2008年收治因输尿管缩窄(28例)、扭曲(7例)、痉挛(11例)或黏膜游离度大(10例)等原因致术中无法安全顺利进镜的患者.均为单侧输尿管结石或肾盂肾盏内结石.均行IVU检查明确结石部位及分肾功能.其中结石位于输尿管中下段20例,上段21例,肾盂或肾盏内结石15例.肾盂或肾盏内结石直径1.0～1.8 cm,平均1.4 cm;输尿管结石直径0.8～1.8 cm,平均1.1 cm.肾盂扩张1.4～3.0 cm,平均2.2 cm.采用9.8 F Wolf输尿管硬镜,进镜困难者尝试换用8 F Storz硬镜,仍无法顺利进镜者改二期手术.C臂X线机监视下将超滑导丝经梗阻部位进入肾盂,留置5 F双J管.术后预防性使用抗生素3 d.2周后拔除双J管,并以输尿管硬镜处理输尿管内结石,使用输尿管软镜处理肾盂肾盏内结石.结果 56例放弃一期手术后均成功留置双J管.41例输尿管结石中,16例输尿管上段结石被推回肾盂内.二期输尿管镜手术中,56例均成功进镜,25例输尿管结石以输尿管硬镜成功碎石,31例肾盂肾盏内结石以输尿管软镜成功碎石.结论 对于因输尿管缩窄、痉挛、扭曲或黏膜游离度大导致无法安全顺利进镜患者,安置导丝留置双J管2周后行输尿管镜手术常可顺利进镜.一期术后应预防性使用抗生素.

abstractsObjective To discuss the feasibility and benefits of staged ureteroscopic laser lithotripsy in complicated cases. Methods From May 2005 to May 2008, the staged ureteroscopic procedure was done in 56 cases for ureteric stricture, kinking, spasm or high mobility of ureteric mucosa. Encountering difficulties, with the guide wire settled in place, the endoscopic procedure was ended and a ureteral stent was set. A second ureteroscopic procedure was carried out two weeks later. Results There was no difficulty for the insertion and the advancing of the ureteroscope two weeks later in all 56 cases. Among the 41 cases previously having the ureteric calculi, the stone was pushed into the kidney by the stent in 16 cases. There was no surgical complication during the second procedure. After three months the complete evacuation rate of the calculus was 96.4%. No patient experienced a fever >39.1 ℃ after the first attempt. Conclusions For complicated cases, such as ureteric stricture, spasm, kinking and high mobility of the ureteric mucosa which hinder the safe advancing of the ureteroscope, staged ureteroscopic procedure might be a safe and effective choice.