输尿管-肠道膀胱扩大成形术治疗上/下尿路功能障碍的长期疗效和安全性研究  

Augmentation uretero-enterocystoplasty for lower urinary tract dysfunction:a long-term retrospective efficacy study

作　　者：廖利民[1,2] 罗润天 周忠涵 付光[1] 陈国庆[1] 张帆[1] 李兴 熊宗胜[1] 鞠彦合[1] 丛惠玲[1] 王祎明 查丽华[1] 吴娟[2] 高轶[2] 靖华芳[2] Liao Limin;Luo Runtian;Zhou Zhonghan;Fu Guang;Chen Guoqing;Zhang Fan;Li Xing;Xiong Zongsheng;Ju Yanhe;Cong Huiling;Wang Yiming;Zha Lihua;Wu Juan;Gao Yi;Jing Huafang(Department of Urology,China Rehabilitation Research Center,Bejing Bo'ai Hospital,Bejing 100068,China;Department of Neurourology,China Rehabilitation Research Center,Bejing Bo'ai Hospital,Bejing 100068,China)

机构地区：[1]中国康复研究中心,北京博爱医院泌尿外科,北京100068 [2]中国康复研究中心,北京博爱医院神经泌尿科,北京100068

出　　处：《中华泌尿外科杂志》2022年第9期651-658,共8页Chinese Journal of Urology

摘　　要：目的探讨输尿管-肠道膀胱扩大成形术(AUEC)的长期疗效和安全性。方法回顾性分析2003年1月至2022年6月于中国康复研究中心接受AUEC的262例下尿路功能障碍患者的资料。男193例,女69例;中位年龄24(4,67)岁,中位病程12.0(0.2,56.0)年,患者术前肌酐91.5(68.1,140.0)μmol/L。320根输尿管存在高等级上尿路扩张积水(UUTD);216根输尿管存在膀胱输尿管反流(VUR),其中14根输尿管为低压反流;低等级VUR输尿管为22根(10.19%),高等级VUR输尿管为194根(89.81%)。术前影像尿动力学检查结果示最大膀胱容量为102(47,209)ml,最大逼尿肌压力为33.0(15.5,50.5)cmH_(2)O(1cmH_(2)O=0.098kPa),膀胱顺应性为6.4(3.0,12.3)ml/cmH_(2)O。所有患者均行AUEC。手术方法:截取一段乙状结肠,将乙状结肠沿对系膜缘剖开,按“去管化”原则折叠缝合成“U”或“S”形的肠补片,同时行输尿管成形和再植,再将肠补片与剖开的膀胱瓣吻合形成扩大的新膀胱。门诊或电话随访,比较患者手术前后肌酐、最大膀胱容量、最大逼尿肌压力、膀胱顺应性、输尿管反流和上尿路扩张情况,并对术后并发症进行评估。结果患者术后中位随访时间为57.4(4,151)个月。术后1~3个月患者最大膀胱容量和膀胱顺应性分别增加至术前的303.9%和189.9%,最大逼尿肌压力降低至术前的63.6%;术后6~10年患者最大膀胱容量和膀胱顺应性增加,分别为术前的490.2%和627.9%,最大逼尿肌压力降低至术前的25.8%。术后UUTD患者显著减少,术后1~3个月高等级UUTD为116根(116/398,29.2%),术后4~6个月为51根(51/274,18.6%),术后6~10年为4根(4/76,5.3%),均较术前显著降低(P<0.001)。术后VUR持续缓解,术后1~3个月393根(393/402,97.8%)输尿管无VUR,术后6~10年73根(73/76,96.1%)输尿管无VUR,无VUR的比例均明显高于术前(P<0.001)。患者术后1~3个月肌酐下降至79.0(65.0,128.2)μmol/L,较术前有下降趋势,但差异无统计学意义(P>0.05),其余术后各�Objective To investigate the long-term efficacy and complications of augmentation uretero-enterocystoplasty(AUEC).MethodsThe clinical data of 262 patients with lower urinary tract dysfunction who underwent AUEC at our center from January 2003 to June 2022 were analyzed retrospectively.There were 193 males and 69 females,the median age was 24(4,67)years,the median disease duration was 12.0(0.2,56.0)years and the preoperative creatinine was 91.5(68.1,140.0)μmol/L.320 ureters had high-grade UUTD,216 ureters had VUR,14 of which had low-pressure reflux.The number of low-grade VUR ureter was 22(10.2%)and the number of high-grade VUR ureter was 194(89.8%).Video-urodynamics showed that the maximum bladder capacity was 102(47,209)ml,the maximum detrusor pressure was 33.0(15.5,50.5)cmH,0,and the bladder compliance was 6.4(3.0,12.3)ml/cmH_(2)O.All patients underwent AUEC.The surgical method is to cut a segment of sigmoid colon,open the sigmoid colon along the mesenteric margin,fold and suture it into"U"or"S"shaped intestinal mesh according to the principle of"detubulization".At the same time,perform ureteroplasty and replanting,and then anastomosis the intestinal mesh with the opened bladder flap to form an expanded new bladder.Follow-up was performed via outpatient clinic or telephone.The creatinine,maximum bladder capacity,maximum detrusor pressure,bladder compliance,ureteral reflux and upper urinary tract dilatation were compared preoperatively and postoperatively.The postoperative complications were also evaluated.Results The median follow-up time was 57.4(4,151)months after surgery.At 1-3 months after surgery,the maximum bladder capacity and bladder compliance increased to 303.9%and 189.9%of the preoperative level,and the maximum detrusor pressure decreased to 63.6%of the preoperative level.At 6-10 years after surgery,the maximum bladder capacity and bladder compliance increased to 490.2%and 627.9%and the maximum detrusor pressure decreased to 25.8%of the preoperative level.The UUTD of the patients was significantly r

关 键 词：下尿路功能障碍 输尿管-肠道膀胱扩大成形术 输尿管再植 疗效 并发症 

分 类 号：R699[医药卫生—泌尿科学]