内镜会师下球囊扩张治疗根治性膀胱全切术后输尿管回肠吻合口狭窄  

Endoscopic balloon dilatation to treat the stricture of uretero-intestinal anastomoses after radical cystectomy

作　　者：安旭方 周建成[2] 丁上书 程永毅[2] 张柱德 李善彦 屈卫星[2] AN Xufang;ZHOU Jiancheng;DING Shangshu;CHENG Yongyi;ZHANG Zhude;LI Shanyan;QU Weixing(Department of Urology,Second Hospital of Xining City,Xining 810003,China;Department of Urology,Shaanxi Provincial People's Hospital,Xi'an 710068,China)

机构地区：[1]西宁市第二人民医院泌尿外科,青海西宁810003 [2]陕西省人民医院泌尿外科病院,陕西西安710068

出　　处：《现代泌尿外科杂志》2021年第12期1001-1004,共4页Journal of Modern Urology

基　　金：陕西省自然科学基金面上项目(No.2020JM-657);陕西省人民医院科技人才支持计划项目(No.2021BJ-05)。

摘　　要：目的探讨内窥镜会师下配合输尿管扩张球囊导管处理输尿管回肠吻合口狭窄部位的临床价值。方法回顾性分析13例根治性膀胱切除、回肠代膀胱术后输尿管回肠吻合口狭窄患者的诊疗资料,平均年龄63.6岁;开放手术2例,腹腔镜手术11例;狭窄位于左侧8例,右侧3例,双侧2例;手术至诊断狭窄时间平均13.7个月;狭窄长度0.5~2.7 cm,平均1.3 cm;2例患者合并肾功能不全,1例因患侧腰痛伴发热就诊,其余为定期随访复查时发现;肾盂分离1.8~4.7 cm,平均2.9 cm。均在全身麻醉下行内镜会师逆行输尿管狭窄段球囊扩张2次,扩张压力20 atm(1 atm=101.325 kPa),留置双根单J管3月。结果手术均顺利完成,手术时间平均63.2 min,术中术后无明显并发症发生,术后住院时间5.3 d。随访平均32月,拔除单J管后2周复查静脉肾盂造影,11例患者肾积水基本消退或轻微;1例复发,行Allium覆膜支架植入,1例双侧患者单侧复发行开放输尿管新的回肠膀胱再吻合术。2例合并肾功能不全患者术后肾功均恢复正常。结论内镜会师下输尿管球囊扩张治疗根治性膀胱全切、回肠膀胱术后输尿管回肠吻合口狭窄损伤小,对于长度不超过2 cm的狭窄疗效肯定。Objective To evaluate the application of endoscopic balloon dilatation to treat the stricture of uretero-intestinal anastomoses by means of retrospective analysis of 13 patients undergoing radical cystectomy.Methods Altogether 13 cases were involved,with an average age of 63.6 years;open surgery was manipulated in 2 cases,while the rest undergoing laparos-copic surgery;in term of strictures,8 cases were on the left side,3 cases were on the right side,and 2 cases were bilateral;the average time of emergence of stricture was 13.7 months;the length of the stricture was 0.5-2.7 cm,with an average of 1.3 cm;2 cases were diagnosed as renal faliure,one of them complainted of low back pain and fever,while the rest completed follow-up;the distension of pelvis in all cases was 1.8-4.7 cm,with an average of 2.9 cm.All patients underwent endoscopic balloon dilatation 2 times under general anesthesia,The pressure was 20 atm(1 atm=101.325 kPa),and duration of the placement of double-J stents lasted for 3 months.Results The operations were successfully completed,with an average operation time of 63.2 minutes.No obvious complications occurred during and after the operation,and the length of hospital stay was 5.3 days.The average follow-up was 32 months.Intravenous phelogram(IVP)was performed within 2 weeks after the removal of the single-J stents.The hydronephrosis in 11 patients vanished;1 case with reoccurece had Allium stent replaced,and 1 bilateral case underwent the open-operation in ureteral neo-bladder on one side.Renal faliure in 2 patients recovered.Conclusion Endoscopic balloon dilatation is an effective approach to treat the strictures of uretero-intestinal anastomoses less than 2 cm in length after radical cystectomy and ileal conduit urinary diversion.

关 键 词：根治性膀胱全切 回肠代膀胱术 输尿管狭窄 球囊扩张 疗效 

分 类 号：R619[医药卫生—外科学]