突发医源性输尿管长段缺损的应对策略(附6例报告)  

Coping strategies of emergency of iatrogenic long segment ureteral defects(Report of six cases)

作　　者：王进 管晓东 张建华 叶敏[2] 

机构地区：[1]运城市中心医院泌尿外科,山西运城044000 [2]上海交通大学医学院附属新华医院泌尿外科

出　　处：《临床泌尿外科杂志》2015年第11期1035-1037,共3页Journal of Clinical Urology

摘　　要：目的:探讨突发医源性输尿管长段缺损的应对策略。方法:回顾性分析6例因输尿管镜碎石而导致输尿管长段缺损的治疗过程。结果:3例行患侧肾切除术,术后恢复良好;1例行离体输尿管复位术,术后3个月出现患侧输尿管挛缩,再行回肠代输尿管术;2例行膀胱肌瓣输尿管成形术。后3例患者术后分别随访12个月,行泌尿系B超、静脉尿路造影及磁共振水成像检查,均提示左肾轻度积水,肾功能检查正常。结论:对于突发医源性输尿管长段缺损的患者,如果对侧肾功能正常,患侧肾重度积水,宜行患肾切除术;其他患者均应根据医院自身条件分Ⅰ期或Ⅱ期手术恢复输尿管的连续性,保护患者肾功能。Objective： To explore the coping strategies of emergency of iatrogenic long segment ureteral defects. Method：We retrospectively analysed and summarized the therapy process of long segment ureteral defects because of ureteroscopic lithotripsy in six cases. Result：Three of them experienced nephrectomy on the affected side and had a good recovery after the operation. One of them received replacing of the ureter, and three months later contracture was found on the affected side ureter. At last ileal replacement of the ureter became inevitable. The rest two patients underwent bladder muscle flap ureteroplasty. The latter three patients were followed up for 12 months. B ultrasonography, IVU and MRU all showed mild uronephrosis on the left side. Their renal function in- dicated normal. Conclusion：For emergency of iatrogenic long s^gment ureteral defects nephrectomy on the affected side is suggested if renal function of the opposite side is normal. Other patients should select one-stage or two- stage surgery in order to restore the continuity of the ureter. Moreover, treatments of protecting renal function are indispensable.

关 键 词：输尿管损伤 医源性 输尿管镜碎石术 

分 类 号：R693[医药卫生—泌尿科学]