The Choice Of Reoperation For Ureteral Stricture Caused By Endovascular Ureteral Surgery And The Analysis Of Its Curative Effect

Background: on this stage,endoluminal ureteral surgery accounts for more than 40% of all department of Urology operations.Ureteroscopic surgery is a minimally invasive surgical approach,but does not mean that the absolute no risk easily with ureteral obstruction,clinical difficult to deal effectively with them,on the one hand it increases the pain of patients in a great extent,on the other hand also increased medical expenses in great extent.Epidemiological data from abroad showed that the incidence of ureteral injury reached about 4%-17%,and the incidence of ureteral stricture was about 30%.At present,ureteral obstruction after iatrogenic ureteral injury has occupied a very important position in the factors that cause adverse effects on the further development of endovascular ureteral surgery.Clinical classification of ureteral obstruction into mechanical power,class two,clinical practice shows that a large part of ureter perforation,mucosal avulsion,mucosal avulsion and other iatrogenic ureteral injuries after ureteral obstruction and hydronephrosis of the imaging performance,the main factors of such patients with ureteral obstruction may not be mechanical stenosis.However,in general,the clinic does not pay much attention to this phenomenon.At present,in the process of processing lead to ureter transluminal surgery after injury in ureteral obstruction,endovascular device technology continues to improve and perfect the affiliated role,although the tendency of growing in number by the Department of Urology Department of Urology physicians,but before surgical intervention must still be a comprehensive assessment of ureteral obstruction in the process,the image study method and make full use of endoscopy.Therefore,under normal circumstances,simple ureteroscopic high pressure balloon dilatation or holmium laser internal incision for the treatment of this kind of patients is not satisfactory,and has a high recurrence rate.The complete resection of the ureteral narrow segment and the reconstruction of the ureteral continuity may be able to be satisfactorily treated.Objective: o analyze the treatment methods and effects of ureteral obstruction caused by ureteral surgery.Methods: he clinical data of 120 cases of patients with ureteral obstruction caused by ureteral surgery in our hospital from November 2011 to November 2015 were retrospectively analyzed,these patients were divided into ureteroscopic minimally invasive surgery group(minimally invasive surgery group,n=60)and open ureteral obstruction segment resection group(open surgery group,n=60)two groups on the basis of surgical treatment methods,the open surgery group were given open segment resection in the treatment of ureteral obstruction,while the minimally invasive surgery group were given ureteroscopic holmium laser endoureterotomy treatment,then the operation time,intraoperative bleeding volumes,postoperative renal function recovery time,hospitalization time,hospitalization expenses and occurrences of postoperative complications and recurrences of the two groups were statistically analyzed.Results: he operation time,postoperative renal function recovery time,hospitalization time of the minimally invasive surgery group were significantly shorter(P<0.05),the amount of bleeding was significantly less than the open surgery group(P<0.05),but the difference of cost of hospitalization between the two groups was not significant(P>0.05);In the minimally invasive surgery group,fever 2 cases,infection 1 case,hematuria 0 case,recurrence 1 case,the postoperative complication rate,recurrence rate were 5.0%(3/60),1.7%(1/60);In the open surgery group,fever 4 cases,infection 2 cases,hematuria 1 case,recurrence 4 cases,the postoperative complication rate,recurrence rate were 11.7%(7/60),6.7%(4/60).The incidence of postoperative complications and recurrence rate of the minimally invasive surgery group were significantly lower than the open surgery group(P<0.05).Conclusion: he effect of ureteroscopic minimally invasive surgery in the treatment of ureteral obstruction caused by ureteral surgery is better than open resection surgery,it can more effectively shorten the operation time and postoperative renal function recovery time,hospitalization time,reduce the amount of intraoperative bleeding,reduce the incidence of complications and recurrence rates of patients,and will not increase the cost for hospitalization in a great extent,so is worthy of promotion and use in the clinical.