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目的探讨顺、逆行输尿管镜下针状电极内切开方法治疗肾盂-输尿管连接部狭窄(UPJO)的疗效。方法回顾分析18例UPJO患者,原发性7例,继发性11例,合并患侧肾盏或肾盂结石(直径大于0.8cm)3例。在C臂X线机的辅助下,通过经皮肾造口顺行或逆行输尿管镜下,采用针状电极内切开技术切开UPJ处狭窄,合并结石患者同期行气压弹道碎石取石术,术中安放双(J5F)管,术后6～8周拔除。平均随访13个月。结果 18例患者手术成功,输尿管狭窄长度小于1.0cm(0.5～1.0cm),无大出血、肾周感染等并发症。拔除双J管后1及3个月复查B超及静脉肾盂造影(IVP),提示肾积水消失或较术前明显减少,UPJO狭窄段消失。4例原发性UPJO拔除双J管12个月后复查UPJO复发,改行开放手术治愈。结论选择适合UPJO患者采用针状电极行输尿管镜下顺、逆行内切开治疗有效、损伤小,适合于狭窄长度小于1.0cm的UPJO患者的治疗;当UPJO合并肾结石及其他需顺行入路情况下,首选顺行经皮肾盂内切开的方法。
Objective To investigate the efficacy of transrectal and retrograde ureteroscopic needle electrode dissection in the treatment of renal pelvis - ureteropelvic stenosis (UPJO). Methods Retrospective analysis of 18 cases of UPJO patients, 7 cases of primary, 11 cases of secondary, with ileal calyx or pelvis (diameter greater than 0.8cm) in 3 cases. Aided by C-arm X-ray machine, percutaneous nephrostomy followed by retrograde ureteroscopy or retrograde ureteroscopy, the use of needle electrode incision open UPJ Department of stenosis, patients with stones in the same period with pneumatic lithotripsy, Intraoperative placement of double (J5F) tube, 6 to 8 weeks after removal. The average follow-up of 13 months. Results Eighteen patients underwent successful operation. The length of ureteral stenosis was less than 1.0 cm (0.5-1.0 cm). No complications such as hemorrhage and perirenal infection were found. One and three months after the removal of double-J tube, B-ultrasound and intravenous pyelography (IVP) were performed, suggesting that the hydronephrosis disappeared or was significantly reduced compared with preoperative, and the narrowing of UPJO disappeared. 4 cases of primary UPJO double J tube removed 12 months after the review of UPJO recurrence, diverted to open surgery to cure. Conclusion The needle-shaped electrode suitable for UPJO patients underwent ureteroscopic cis and retrograde incision open treatment is effective, less damage, suitable for the treatment of patients with UPJO stenosis less than 1.0cm length; when the UPJO with renal stones and other need to be followed Case, the preferred method of percutaneous renal pelvis incision.