原位尿流改道术后输尿管储尿囊吻合处狭窄的处理体会  

Treatment of stenosis of ureter and pouch anastomosis undergone orthotopic urinary diversion

作　　者：邱学德[1] 李泽惠[1] 曹贵华[1] 夭志刚 方克伟[1] 李志鹏[1] 袁顺辉[1] 何进[1] 和术臣[1] 李海丹[1] 徐鸿毅[1] 

机构地区：[1]昆明医科大学第二附属医院泌尿外科,云南昆明650101

出　　处：《现代泌尿外科杂志》2014年第6期381-383,398,共4页Journal of Modern Urology

摘　　要：目的 探讨原位尿流改道术后输尿管肠储尿囊吻合处狭窄患者诊断和治疗.方法 回顾性总结542例原位尿流改道术后患者中35例共37侧输尿管储尿囊吻合处狭窄诊断和治疗经验,平均年龄57（51～67）岁,其中男性34例,女性1例.狭窄段＜1.5 cm,且能通过导丝和球囊管者顺行球囊扩张至F14～F6,失败者经肾造瘘管注入亚甲蓝引导导丝和输尿管镜插入,作逆行镜体扩张和等离子柱状电极内切开;上述方法失败或狭窄段超过1.5 cm,开放手术再植.Fisher＇s检验比较球囊扩张和等离子切开两种方法的狭窄复发率.结果 16侧肾输尿管行球囊或镜体和或扩张器扩张者3例（18.7％）狭窄复发,13侧肾输尿管作等离子柱状电极切开者复发1例（7.7％,P=0.031 4）.7侧肾输尿管行开放手术再植治疗无复发.1侧肾输尿管行患侧肾切除.术后3月内获得治疗者肾功能恢复优于术后3月后获得治疗者.结论 早期诊断和治疗狭窄利于肾功能恢复;多数输尿管储尿囊吻合处狭窄可通过腔内治疗,等离子内切开优于扩张.Objective To investigate the diagnosis and treatment of stenosis of ureter and intestinal pouch undergone or thotopic urinary diversion.Methods The diagnosis and treatment of 35 cases （37 ureters） with stenosis of ureter and pouch anastomosis among 542 patients undergone orthotopic urinary diversion were summarized retrospectively,including 34 males and 1 female,with the mean age of 57 （ranging from 51 to 67） years.All patients were preliminarily diagnosed with IVU and finally with anterograde nephrostomy tube opacification.The stenosis segment was less than 1.5 cm,the guide wire and sacculus tube could pass the stenosis,and was dilated to F14-F16.When the guide wire failed to cross the stenosis,it was inserted and ureteroscope was guided by methylenum which was infused via nephrostomy tube.After the stenosis was dilated by body of ureteroscope retrogradely,endoureterotomy to F14-F16 by plasma pillar electrode was performed.If all of above methods failed,or the stenosis segment was more than 1.5 cm,an open ureter reimplant was performed.Fisher＇s test was used to compare the recurrence rate of stenosis.Results Altogether 16 ureters underwent the dilatation,and stenosis recurred in 3（18.7%） of them.13 ureters received endoureterotomy,and stenosis recurred in 1 （7.7%） of them,（P〈0.05）.7 cases received open operation and no stenosis recurred.1 case underwent nephrotectomy because of renal function loss.The renal function recovered better in patients who gained therapy in 3 months than after 3 months.Conclusions Early diagnosis was essential for the recovery of renal function.Most of the stenosis was cured by intracavitery therapy.The result of plasma pillar electrode incision was superior to that of dilation.

关 键 词：原位尿流改道 输尿管狭窄 狭窄扩张 狭窄等离子内切开 

分 类 号：R737.14[医药卫生—肿瘤]