输尿管镜的临床应用.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,输尿管肾镜的临床应用,1,.,历史：,1.Marshall VF:Fiberoptics in urology.J Urol 1964;91:110.,2.Takagi T:Small caliber fiberscope for visualization of the urinary tract,biliary tract,and spinal canal.Surgery 1968;64:1933.,3.Takagi T:Fiberoptic pyeloureteroscope.Surgery 1971;70:661.,4.Goodman TM:Ureteroscopy with pediatric cystoscope in adults.Urology 1977;9:394.,5.Perez-Castro E:Transurethral ureteroscopy-a current urological procedure.Arch Esp Urol 1980;33:445.,2,.,输尿管肾镜安全使用的基础：,1.,了解上尿路的解剖,2.,了解所使用设备的性能,3.,掌握输尿管肾镜的适应症,4.,了解输尿管肾镜的并发症和治疗方法,3,.,上尿路解剖：,肾脏,输尿管：,长度：,右,2834cm(2530cm),左比右侧短,1cm,相对狭窄段：,壁段,12mm,跨越髂总,3mm,连接部,2mm,输尿管口之间约,5cm(23cm),膀胱壁内段约,2cm(12cm),组织结构：,肾盂和输尿管壁厚,12mm,管腔直径,25mm,纤维膜（入膀胱段,Waldeyer,鞘）,肌层（上段,2,层，中下段三层）,固有层，粘膜（肾盏,2,层移行上皮，远端输尿管,56,层）,4,.,设备,1.,输尿管肾镜：软性，硬性,2.,扩张泵，光源，光纤,3.,导丝，扩张器，异物钳，取石钳，活检钳,4.,碎石设备,钬激光,超声,气压弹道碎石,液电碎石,5,.,输尿管肾镜适应症,结石,下段输尿管结石,上段输尿管结石，,ESWL,失败,肾盂结石，,ESWL,失败,ESWL,术后石街,结石合并梗阻,结石同时怀疑肿瘤,诊断,x,线检查发现充盈缺损或梗阻,单侧输尿管喷血或细胞学阳性,上尿路肿瘤保留器官手术后复查,其他疾病的治疗,输尿管梗阻或窦道放管,取出异物,有选择的肿瘤切除,狭窄段的扩张或切开,6,.,