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目的探讨逆行输尿管镜手术的常见并发症及防治策略。方法回顾性分析本院2003年1月~2009年8月有随访资料的逆行输尿管镜手术1707例(1734侧)。其中男1 047例,女660例;年龄16~86岁,平均(50.31±13.62)岁;治疗1 632例,诊断75例。随访3~45个月(平均26个月)。结果术中并发症3.75%(64例):输尿管损伤(穿孔、黏膜下假道、黏膜长段撕脱、断裂、管口裂伤)2.11%(36例),肾脏破裂2例,膀胱破裂1例、大出血1例,尿道损伤1例,结石移位1.35%(23例)。近期(术后1月内)并发症6.21%(106例):严重血尿(鲜血样,>3 d)1.05%(18例);发热(T>38.5℃)2.52%(43例);肾周积液0.53%(9例);肾绞痛0.76%(13例);双J管位置不正1.11%(19例),移位0.23%(4例)。远期并发症0.94%(16例):输尿管狭窄0.76%(13例);双J管拔管困难0.18%(3例)。手术开展早期(2003年1月~2004年12月)并发症发生率(19.73%)显著高于中期(2005年1月~2006年12月)和后期(2007年1月~2009年8月),分别为9.83%和6.24%,差异有显著性意义(P<0.05);而开展中期和后期阶段差异并无显著性意义(P>0.05)。结论输尿管镜手术并发症与对适应证的掌握、操作熟练程度、术中灌注压等相关,因此,对初学者进行充分的培训是必需的。
Objective To investigate the common complications and prevention and treatment of retrograde ureteroscopic surgery. Methods Retrograde ureteroscopy in our hospital from January 2003 to August 2009 was retrospectively analyzed in 1707 patients (1734 side). There were 1 047 males and 660 females, aged from 16 to 86 years, with an average of (50.31 ± 13.62) years; 1632 cases were treated and 75 cases were diagnosed. Followed up for 3 ~ 45 months (average 26 months). Results The intraoperative complications were 3.75% (64 cases): 2.11% (36 cases) of ureteral injury (perforation, submucosal falsectomy, long mucosal avulsion, rupture of mucosa), 2 cases of renal rupture, 1 case of ruptured bladder Cases, 1 case of hemorrhage, urethral injury in 1 case, stone metastasis 1.35% (23 cases). In the short term (within 1 month after operation), complications were 6.21% (106 cases): severe hematuria (blood sample,> 3 days) 1.05% (18 cases); fever (T> 38.5 ℃) 2.52% 0.53% of effusion (n = 9), renal colic of 0.76% (n = 13), malposition of double J-tube of 1.11% (n = 19) and displacement of 0.23% (n = 4). Long-term complications 0.94% (16 cases): ureteral stricture 0.76% (13 cases); double J tube extubation 0.18% (3 cases). The incidence of complications (19.73%) in the early stage of operation (January 2003 to December 2004) was significantly higher than that in the middle stage (January 2005 to December 2006) and late stage (January 2007 to August 2009) , Respectively, 9.83% and 6.24%, the difference was statistically significant (P <0.05); but there was no significant difference between the mid-stage and the late stage (P> 0.05). Conclusions The complications of ureteroscopic surgery are related to the mastery of indications, proficiency in operation and intraoperative perfusion pressure. Therefore, it is necessary to provide adequate training for beginners.