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目的探讨内镜手术治疗医源性损伤导致输尿管阴道瘘的方法及临床效果。方法 2005年2月~2013年1月,选取42例医源性输尿管损伤后输尿管阴道瘘,采用经皮肾穿刺造瘘Wolf F9.8输尿管短镜联合经尿道输尿管长镜引导置入双J管行输尿管会师术。结果 2例失败,肾造瘘术后3个月行开放手术。40例手术成功者漏尿于术后逐渐减少并在48小时内停止。术后1个月输尿管窦道基本成形,术后2个月拔除肾造瘘管,3个月复查静脉肾盂造影(IVP),患侧输尿管通畅,拔双J管。随访6~24个月,平均14.7月,无并发症发生。结论经皮肾穿刺造瘘联合经尿道输尿管镜下输尿管会师术是处理输尿管阴道瘘的有效治疗方法。
Objective To investigate the methods and clinical effects of endoscopic surgery for ureteral fistulas induced by iatrogenic injury. Methods From February 2005 to January 2013, 42 cases of iatrogenic ureteral fistula after iatrogenic ureteral injury were selected and percutaneous nephrostomy combined with Wolf F9.8 ureteroscope and transurethral ureteroscope were used to guide double-J tube Ureteral surgery will be. Results 2 cases failed, 3 months after nephrostomy open surgery. 40 cases of successful surgery, leakage of urine gradually decreased after surgery and stopped within 48 hours. One month after operation, the urethral sinus was basically formed. Nephrostomy tube was removed 2 months after operation. Intravenous pyelography (IVP) was performed at 3 months. The ureter of the affected side was unobstructed and double J tube was pulled out. Follow-up 6 to 24 months, an average of 14.7 months, no complications. Conclusion Percutaneous nephrostomy combined with transurethral ureteroscopic ureterrectomy is an effective treatment for ureteroscopic fistula.