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目的探讨电刀内切开联合球囊扩张治疗输尿管狭窄的安全性和疗效。方法回顾性分析2007年5月至2016年3月我院应用电刀内切开联合球囊扩张治疗输尿管狭窄469例的临床资料,术中通过逆行、顺行或者逆行+顺行三种途径置入安全导丝后,先使用电刀内切开输尿管狭窄段全层,再使用21 F球囊扩张器扩张,留置双J管,定期复查随访评估手术效果。结果 469例中采用逆行途径370例,顺行途径50例,顺行+逆行途径49例。术中1例因移植肾输尿管膀胱连接部内切开大出血中转开放手术,止血成功,现长期更换支架管治疗。肾盂输尿管连接部狭窄电刀切开术后出血5例,保守治疗成功。术后1年获随访381例,275例(72.2%)一次手术治愈;106例出现狭窄复发,其中57例行2~5次腔镜下狭窄段扩张后治愈,5例改作开放手术治愈,13例改用金属网状支架植入术治愈,17例长期定期更换双J管,8例长期留置肾造瘘管,6例行患肾切除术。结论电刀内切开联合球囊扩张治疗输尿管狭窄是安全、可靠、有效的,特别对于狭窄段较短、程度较轻和患肾功能较好的病例可作为首选治疗方案。
Objective To discuss the safety and curative effect of electric knife incision combined with balloon dilation in the treatment of ureteral stricture. Methods The clinical data of 469 cases of ureteral stricture treated with electric knife combined with balloon dilatation in our hospital from May 2007 to March 2016 were retrospectively analyzed. There were three ways to retrograde, retrograde or retrograde in operation Into the safety guide wire, the first use of electric knife incision ureteral stricture full-thickness, and then use the 21 F balloon dilator expansion, double J tube indwelling, regular review follow-up evaluation of surgical results. Results Among the 469 cases, 370 cases were retrograde, 50 cases were retrograde and 49 cases were retrograde retrograde. Intraoperative bleeding in 1 case due to renal pelvis and ureter transitional hemorrhage transfer open surgery, hemostasis success, is the long-term replacement of stent treatment. 5 cases of ureteropelvic junction stenosis after electric knife incision bleeding, conservative treatment was successful. One year after operation, 381 patients were followed up and 275 patients (72.2%) were cured by one operation. Sixty-seven patients had stenosis and recurrence. Among them, 57 patients underwent 2 to 5 times of endoscopic stenosis and were cured after the expansion. 5 patients were cured by open surgery and 13 Cases were treated with metal mesh stent implantation, 17 cases of long-term regular replacement of double J tube, 8 cases of long-term indwelling nephrostomy, 6 cases of nephrectomy. Conclusion Electric knife incision combined balloon dilatation in the treatment of ureteral stricture is safe, reliable and effective, especially for the short segment of the lesser degree of light and better renal function can be used as the preferred treatment options.