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目的:探讨硬性输尿管镜钬激光碎石术并发输尿管损伤的原因和防治。方法:对2005年7月~2015年11月经尿道硬性输尿管镜钬激光碎石术的302例中的6例并发输尿管损伤患者的临床资料进行回顾性分析。结果:输尿管穿孔4例中,3例中转开放手术,经输尿管端端吻合术治愈;1例终止手术,留置双J导管,后经体外冲击波碎石治愈。输尿管黏膜剥脱伤1例,中转开放手术,经输尿管膀胱瓣吻合术治愈。输尿管膀胱连接部狭窄1例,后经输尿管膀胱再植术治愈。结论:硬性输尿管镜钬激光碎石术并发输尿管损伤与术者的经验和手术技巧密切相关,提高对硬性输尿管镜钬激光碎石术并发输尿管损伤的认识,加强技能训练,尽可能使用先进的医疗器械等是减少输尿管损伤,提高手术成功率的关键。
Objective: To investigate the causes and prevention of ureteroscopic ureteroscopic holmium laser lithotripsy. Methods: The clinical data of 6 patients with ureteral injury in 302 cases of transurethral ureteroscopic holmium laser lithotripsy from July 2005 to November 2015 were analyzed retrospectively. Results: In 4 cases of ureter perforation, 3 cases were switched to open surgery and were cured by ureter end anastomosis. One case was terminated with double J catheter, and then treated by extracorporeal shock wave lithotripsy. One case of ureteral mucosal exfoliation injury, transit open surgery, ureteral bladder anastomosis was cured. One case of ureterovesical stenosis, followed by ureteral bladder replantation. Conclusions: Hard ureteroscopic holmium laser lithotripsy combined with ureteral injury is closely related to the surgeon’s experience and surgical skills, to improve understanding of rigid ureteroscopic holmium laser lithotripsy with ureteral injury, to enhance skills training, and to use advanced medical treatment where possible Instrument is to reduce ureteral injury, improve the success rate of the key to surgery.