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目的探讨输尿管镜钬激光治疗输尿管结石合并息肉后输尿管再狭窄的治疗策略。方法2003年12月~2004年8月,我院应用输尿管镜钬激光治疗输尿管结石67例,其中合并输尿管息肉5例术后1~2个月出现输尿管管腔再狭窄、闭锁,再次开放手术行输尿管部分切除、输尿管端端吻合(4例)或膀胱再植术(1例)。结果随访1~2个月,4例肾积水消失,1例双侧输尿管狭窄者肾积水减轻,血肌酐由700.3μmol/L降至165μmol/L。结论对围绕输尿管壁环形生长,广基多发,且生长有息肉的输尿管长度>1 cm的输尿管纤维上皮息肉的处理,不宜应用输尿管镜钬激光汽化,而适宜开放手术切除部分输尿管,行输尿管端端吻合或输尿管膀胱再植手术。
Objective To investigate the therapeutic strategies of ureteroscopic holmium laser for the treatment of ureteral calculi after ureteral calculi combined with polyps. Methods From December 2003 to August 2004, ureteroscopic ureteroscopic ureteroscopic holmium laser was used in our hospital to treat 67 cases of ureteral calculi, of which 5 cases with ureteral polyps underwent ureteral lumen restenosis within 1 to 2 months after operation, atresia and reoperation Partial ureterotomy, ureter end anastomosis (4 cases) or bladder replantation (1 case). Results 1 to 2 months follow-up, 4 cases of hydronephrosis disappeared, 1 case of bilateral ureteral stricture were reduced hydronephrosis, serum creatinine from 700.3μmol / L to 165μmol / L. Conclusion Surgical treatment of ureteral fibroepithelial polyp around the ureteral wall with ring-shaped growth, wide-base polyps, and polyp growth is not suitable for ureteroscopic holmium laser vaporization, and is suitable for open surgery to remove part of the ureter and ureter end Anastomosis or ureter bladder replantation surgery.