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目的:探讨输尿管镜术中困难和并发症的原因及应对策略。方法:回顾性分析1998年3月～2008年10月行输尿管镜手术的900例患者临床资料。结果:900例患者中,术中困难83例,其中45例为早期病例;中转开放手术24例,其中14例为早期病例。24例中转开放手术的原因为:未找到输尿管3例(12.5%),入镜失败5例(20.9%),上镜困难(未达到病变部位)5例(20.9%),输尿管穿破7例(29.1%),输尿管断裂2例(8.3%),结石上移2例(8.3%)。结论:输尿管镜术中困难和并发症与操作者的经验密切相关,掌握手术适应证,术前加强培训,熟练操作技巧,是减少手术失败率和并发症的关键。
Objective: To investigate the causes and strategies of the difficulties and complication in ureteroscopy. Methods: The clinical data of 900 patients undergoing ureteroscopic surgery from March 1998 to October 2008 were retrospectively analyzed. Results: Of the 900 patients, 83 were intraoperatively difficult, of which 45 were early; 24 were open and open surgery, of which 14 were early. Among the 24 cases who underwent open surgery, 3 cases (12.5%) failed to find the ureter, 5 cases (20.9%) failed to enter the mirror, 5 (20.9%) had difficulty in finding the mirror (20.9% 29.1%), 2 cases of ureteral rupture (8.3%) and 2 cases of stone metastasis (8.3%). Conclusions: The difficulties and complications in ureteroscopy are closely related to the experience of the operator. To master the indications for surgery, to strengthen training and skillful operation before surgery is the key to reduce the rate of operation failure and complications.