各类输尿管瘘原因及预后分析  

Analysis of causes and prognosis of ureteral fistula

作　　者：何君伟 潘俊 白遵光 王昭辉 王树声 He Junwei;Pan Jun;Bai Zunguang;Wang Zhaohui;Wang Shusheng(Department of Urology,the Second Clinical College of Guangzhou University of Chinese Medicine,Guangzhou,510120,China)

机构地区：[1]广州中医药大学第二临床医学院泌尿外科,510120

出　　处：《中华腔镜泌尿外科杂志（电子版）》2022年第1期69-72,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的对输尿管瘘患者临床资料及不同处理方式疗效进行回顾分析,总结临床诊治经验。方法我科自2013年5月至2018年5月共收治19例各类原因所导致的输尿管瘘患者,其中男性4例,女性15例,平均年龄为(51±13)岁。19例患者中,17例患者首先进行输尿管镜检+输尿管支架管(双J管)置入术,如输尿管镜检失败,则视情况改行肾造瘘术或输尿管膀胱再植术;2例因感染较重,且腹膜后尿囊明显,遂行尿囊穿刺引流术+患肾造瘘术。结果8例患者成功行输尿管镜检+双J管置入术,5例最终恢复正常;9例逆行输尿管镜检失败的患者,3例直接同期行输尿管膀胱再植术;6例改行肾造瘘术,其中3例因后期瘘口未愈,半年后行输尿管膀胱再植术。3例患者因反复感染,最终切除患肾。结论如果Ⅰ期输尿管镜检查术可恢复输尿管连续性,可尝试留置双J管;如Ⅰ期输尿管镜检查术失败,患者条件允许情况下,则应选择同期行输尿管修补术或输尿管膀胱再植术,单纯行肾造瘘术只会延长病程并不能改变患者最终结局;感染是导致输尿管瘘患者最终切肾的主要因素。Objective To analyze of clinical data of patients with ureteral fistula and to explore the efficacy of different treatment methods.Methods 19 cases of ureteral fistula caused by various causes were treated in our department from May 2013 to May 2018.There were 4 males and 15 females with an average age of(51±13).Among the 19 patients,17 patients underwent ureteroscopy and double-J stenting firstly.If ureteroscopy failed,percutaneous nephrostomy or ureteral reimplantation was performed as appropriate.Because of severe infection and obvious allantois,2 cases were treated with percutaneous nephrostomy and drainage.Results Successful ureteroscopy and double-J stenting was performed in 8 cases,and 5 cases finally were cured.Among 9 cases failed of ureteroscopy,3 cases underwent ureterocystectomy at the same time.Percutaneous nephrostomy was performed in 6 cases,3 cases of them underwent ureteral reimplantation half a year later due to the inrecovery of anaphase fistula.3 patients underwent nephrectomy due to repeated infection.Conclusion If the ureteroscopy can restore the ureteral continuity,we can try to indwell the double-J stenting.While the ureteroscopy failed,the ureter repair or ureteral reimplantation should be performed at the same time.Nephrostomy will only prolong the course of the disease and cannot change the final outcome.Infection is the main factor leading to final nephrectomy in patients with ureteral fistula.

关 键 词：医源性损伤 输尿管瘘 输尿管膀胱再植术 

分 类 号：R699.4[医药卫生—泌尿科学]