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目的探讨输尿管镜术应对特殊输尿管条件下(肾移植术后、下肢、脊柱畸形)的有效方法。方法 2007-2010年收治的移植肾输尿管梗阻51例(移植肾输尿管狭窄30例、移植肾输尿管结石21例),下肢、脊柱畸形伴输尿管结石16例;输尿管结石直径0.7 cm～1.5 cm,平均1.1 cm,肾盂扩张1.5 cm～3.2 cm,平均2.3 cm。采用F8/9.8Wolf及F6/7.6输尿管硬镜,进镜困难则配合双合诊和改变体位(抬高腰部、抬高或降低患侧、头低或头高位)牵拉输尿管配合进镜,若无法顺利进镜,置入导丝,留置F5双J管,2周后拔除双J管,并以输尿管镜处理输尿管结石及狭窄。结果 53例进镜困难者经双合诊和改变体位牵拉输尿管后输尿管镜顺利进入病变部位,输尿管狭窄及结石处理成功;14例进境失败者,顺导丝置入F5双J管,2周后顺利进镜,成功处理狭窄及结石。结论对于肾移植术后、下肢、脊柱畸形等特殊输尿管条件因存在输尿管走形异常、狭窄、迂曲,选择合适的输尿管镜配合双合诊及改变体位能提高输尿管进镜成功率,对于无法顺利进镜患者,留置双J管2周后行输尿管镜手术常可顺利进境。
Objective To investigate the effective methods of ureteroscopic surgery in treating special ureter (renal allograft, lower extremity and spinal deformity). Methods 51 cases of transplanted renal ureteral obstruction (30 cases of transplanted renal ureteral stricture, 21 cases of transplanted renal ureteral calculi) were treated in 2007-2010, and 16 cases of lower extremity and spinal deformity with ureteral calculi. The diameter of ureteral calculi was 0.7 cm ~ 1.5 cm with an average of 1.1 cm, pyel extension 1.5 cm ~ 3.2 cm, an average of 2.3 cm. With F8 / 9.8Wolf and F6 / 7.6 ureteroscopy, difficult to enter the mirror with double consultation and change position (raise the waist, raise or lower the affected side, head low or head high) with ureter pull into the mirror, if Can not successfully into the mirror, into the guide wire, indwelling F5 double J tube, remove the double J tube after 2 weeks, and ureteroscopic treatment of ureteral calculi and stenosis. Results 53 cases of difficult to enter the mirror by double co-diagnosis and postural urethral traction to change the position into the lesion, ureteral stricture and stones were successfully treated; 14 cases of failed entry, cis-guide wire F5 double J tube, 2 Smoothly into the mirror after the week, the successful treatment of stenosis and stones. Conclusions After renal transplantation, the special ureteral conditions such as lower extremity and spinal deformity may lead to abnormal ureteral catheterization, stenosis and tortuosity. Choosing appropriate ureteroscopy combined with double orthodontic treatment and changing position can improve the success rate of ureteroscopy. Mirror patients, indwelling double J tube 2 weeks after ureteroscopic surgery can often smoothly enter.