【摘要】：目的探討電切鏡聯(lián)合輸尿管鏡在腺性膀胱炎中尋找困難輸尿管開口的方法,提高內(nèi)鏡下置入雙J管的成功率。方法回顧性分析2015年3月-2016年5月,8例腺性膀胱炎合并有困難輸尿管開口的患者的臨床資料。均為男性患者,年齡38~64歲,平均44.3歲。電切膀胱內(nèi)病變,切除深度為黏膜下層和肌層,將輸尿管開口區(qū)域的壞死組織切除干凈,切除深度能夠顯露肌層的紋理改變。進(jìn)一步切除肌肉組織,透過薄層肌肉組織能夠看見尿液。在導(dǎo)絲引導(dǎo)下置入輸尿管鏡,鏡下觀察證實(shí)為輸尿管管腔。在導(dǎo)絲引導(dǎo)下留置雙J管一根。結(jié)果 8例患者(16側(cè))均應(yīng)用電切鏡聯(lián)合輸尿管鏡成功置入雙J管。手術(shù)時(shí)間35~205 min,平均時(shí)間83.2 min,術(shù)中失血量約20~50 ml。術(shù)后3~5天拔除尿管。術(shù)后1或2天復(fù)查腹部平片,顯示雙側(cè)雙J管位置良好,沒有出現(xiàn)異位、扭曲等現(xiàn)象。圍手術(shù)期未出現(xiàn)并發(fā)癥。結(jié)論應(yīng)用電切鏡聯(lián)合輸尿管鏡在腺性膀胱炎中尋找困難輸尿管開口,能夠提高尋找輸尿管開口成功的概率,此方法安全、創(chuàng)傷小、避免開放手術(shù)。
[Abstract]:Objective to explore the method of finding difficult ureteral orifice in cystitis glandularis by electroresection combined with ureteroscope, and to improve the success rate of double J tube placement under endoscope. Methods the clinical data of 8 patients with cystitis glandularis complicated with difficult ureteral orifice from March 2015 to May 2016 were retrospectively analyzed. All patients were male, aged 38 to 64 years (mean 44.3 years). The depth of resection was submucosa and muscular layer. The necrotic tissue in the area of ureteral orifice was excised. The depth of resection could reveal the texture of myometrium. Further excision of muscle tissue, through the thin layer of muscle tissue can see urine. The ureteroscope was placed under the guidance of the guide wire, and the ureteral cavity was confirmed by the observation under the microscope. A double J tube is retained under the guide of the guide wire. Results 8 cases (16 sides) were successfully implanted with double J tube by electroresection combined with ureteroscope. Mean time of operation: 35 ~ 205 min,: 83. 2 min,. Blood loss during operation is about 20 to 50 ml. Urinary catheter was removed 3 days after operation. 1 or 2 days after operation, the abdominal plain film showed that the bilateral J tubes were well located, no ectopia, distortion and so on. There were no complications during the perioperative period. Conclusion finding the difficult ureteral orifice in cystitis glandularis with electroresection combined with ureteroscope can increase the probability of success in finding ureteral orifice. This method is safe, less traumatic and avoids open operation.
【作者單位】： 河北醫(yī)科大學(xué)第二醫(yī)院泌尿外科;
【基金】：河北醫(yī)科大學(xué)第二醫(yī)院科學(xué)研究基金項(xiàng)目(No:2h1201623)
【分類號(hào)】：R694.3

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