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经尿道逆行球囊扩张术治疗小儿输管术后狭窄的效果 预览

Transurethral retrograde balloon dilatation for postoperative ureteral stricture in children
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摘要 目的探讨利用膀胱镜经尿道逆行球囊扩张术治疗小儿输尿管术后狭窄的效果。方法回顾性分析本院介入科、泌尿外科2017年11月至2018年12月收治的7例明确诊断为单侧输尿管术后狭窄患儿,男5例,女2例,年龄最小7月,最大8岁,患者均为腹腔镜下输尿管-肾盂离断吻合术后吻合口狭窄,其狭窄长度<2.0cm,术前明确狭窄部位、程度以及肾功能情况,对合并泌尿系感染术前得到控制,通过膀胱镜联合DSA施行经尿道逆行高压球囊扩张术,术后留置双J管3~6月,随访时间从置入双J管之后开始计算,根据随访过程中患者临床症状及影像学表现分析疗效。结果7例患者手术均在全麻下成功完成手术,术中未改变手术方式,术中、术后未输血,无并发症发生,术后3d出院,随访3~12月,5例患者1年后梗阻解除,肾功能较前恢复,1例球囊扩张后2月再次出现严重狭窄,改腹腔镜下肾盂-输尿管离断吻合术,1例术后随访12个月后再次狭窄,改腹腔镜下肾盂-输尿管离断吻合术,球囊扩张总有效率为71.4%(5/7)。结论对于长度<2cm的小儿输尿管狭窄术后的患者经尿道逆行球囊扩张术安全、微创、有效,缩短住院天数,部分患者避免再次外科手术,球囊扩张术可以成为治疗小儿输尿管术后狭窄的首选方式。 Objective To explore the efficacy of transurethral retrograde balloon dilatation through cystoscope for postoperative ureteral stricture in children. Methods 7 cases with definite diagnosis of benign postoperative ureteral stricture on one side, who were treated at intervention and urinary surgery department of our hospital between November, 2017 and December, 2018, were retrospectively analyzed. Among them, 5 cases were male, and 2 female. The youngest was 7 months old, and the oldest 8 years old. They were all diagnosed as postoperative ureteral stricture after laparoscopic ureteropelvis anastomosis, with a narrow length < 2.0 cm. The location and degree of stricture and renal function should be known before the operation, and urinary tract infection should be controlled if there was. Transurethral retrograde high pressure balloon dilatation was operated through cystoscope and DSA. Double J tube was indwelled 3 to 6 months after the operation. The follow-up time was calculated from the time after the placement of the double J tube. The efficacy was analyzed according to the clinical symptoms and imaging manifestations of the patients during the follow-up. Results The surgeries of 7 cases were all successfully completed under general anesthesia, without changing the mode of operation, and no blood transfusion before and after operation and no complications occurred. They were discharged three days after the operation, with a follow-up of 3-12 months. 1 year later, the obstruction of 5 cases disappeared and their renal function were improved. 1 case suffered again severe stricture 2 months after balloon expansion, and the operation was replaced by laparoscopic ureteropelvis anastomosis;1 case suffered again stricture after 12 months’ followup, and the operation was replaced by laparoscopic ureteropelvis anastomosis. The total effective rate of balloon dilatation was 71.4%(5/7). Conclusion Transurethral retrograde balloon dilatation is safe, minimally invasive and effective for children with benign ureteral stri
作者 梅世伟 邓志真 贺小明 罗辉 劳伟华 叶志球 Mei Shiwei;Deng Zhizhen;He Xiaoming;Luo Hui;Lao Weihua;Ye Zhiqiu(Department of Radiology,Guangdong Maternal and Child Health Care Hospital,Guangzhou 510000,China)
出处 《国际医药卫生导报》 2019年第13期2112-2115,共4页 International Medicine & Health Guidance News
关键词 球囊扩张 介入 小儿输尿管良性狭窄 Balloon dilatation Intervention Benign ureteral stricture in children
作者简介 通信作者:叶志球,Email:ye0542@sina.cn.
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