膀胱肌瓣在尿路梗阻性病变修复重建中的疗效分析  

The efficacy of pedicledd bladder muscle flap in the repair and reconstruction of urinary tractobstruction

作　　者：叶绪晓 撒应龙 金重睿 胡晓勇 燕东亮 宋汶雄 王继剑 吕蓉 Ye Xuxiao;Sa Yinglong;Jin Chongrui;Hu Xiaoyong;Yan Dongliang;Song Wenxiong;Wang Jijian;Lyu Rong(Department of Urology,Shanghai Sixth Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai Eastern Institute For Urological Repair and Reconstruction,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院泌尿外科,上海东方泌尿修复重建研究所,上海200233

出　　处：《中华泌尿外科杂志》2023年第5期354-358,共5页Chinese Journal of Urology

摘　　要：目的探讨膀胱肌瓣组织在邻近尿路梗阻性病变修复重建中的疗效。方法回顾性分析2016年3月至2021年6月上海交通大学医学院附属第六人民医院收治的26例尿路梗阻性疾病患者的临床资料。男14例, 女12例;年龄2~75岁。26例中, 12例为男性前列腺增生手术后难治性膀胱颈部梗阻, 年龄(70.0±3.5)岁, 12例均有≥2次经尿道狭窄段内切开或电切术, 其中9例留置膀胱造瘘管。6例女童为车祸外伤骨盆骨折后膀胱颈部及近端尿道闭锁, 年龄(10.5±2.1)岁, 尿道造影检查示缺损长度为1~2 cm。8例为输尿管下段狭窄或缺损(男2例, 女6例);其中4例为输尿管镜激光碎石术引起, 4例为子宫肌瘤切除术引起;8例年龄(55.0±3.2)岁;8例静脉尿路造影/CT尿路造影(CTU)检查输尿管狭窄或缺损长度为5~6 cm。治疗方法:前列腺增生手术后难治性膀胱颈部梗阻患者, 采用膀胱肌瓣尖端推移插入远端正常尿道黏膜后膀胱颈部"Y-V"成形;车祸后膀胱颈部及近端尿道闭锁的女童患者, 采用2~4 cm的膀胱肌瓣扩大重建膀胱颈与近端尿道。以上两类患者留置导尿管3~4周, 术后4周、3个月行尿流率和尿道镜检查评估手术效果。输尿管下段狭窄或缺损患者, 取7~8 cm膀胱肌瓣管状成形重建输尿管下段, 保留输尿管内支架管4周, 术后4周、3个月行超声和静脉尿路造影/CTU检查, 评估重建输尿管管腔通畅程度及是否合并肾积水、腰背部疼痛、泌尿道感染等。结果 26例手术均顺利完成, 无组织坏死、感染等并发症。术后随访(8.2±2.2)个月, 12例前列腺术后难治性膀胱颈部梗阻患者术后拔除导尿管, 10例可恢复正常排尿, 最大尿流率(Q_(max)) (17.2±2.8) ml/s;2例有排尿困难, 定期行尿道扩张治疗。6例女童膀胱颈部及近端尿道闭锁者术后4周拔除导尿管, 5例可顺利排尿并可控尿, Q_(max)为(16.7±1.1)ml/s;1例合并尿失禁, 等待后续治疗。8例输尿管下�ObjectiveTo explore the efficacy of pedicled bladder muscle flap in the repair of urinary tract obstruction.Methods The data of 26 patients with urinary tract obstruction admitted to Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2016 to June 2021 were retrospectively reviewed.There were 14 males and 12 females,with the age ranged from 2 to 75 years old.Refractory bladder neck obstruction after prostatic hyperplasia surgery in 12 cases,with the age of(70.0±3.5)years old.They all experienced at least 2 times of transurethral stenosis incisionor resection.Transpubic cystostomy tube was placed in 9 patients.Posttraumatic pelvic fractures lead to bladder neck atresia and urethral injury in 6 girls,with the age of(10.5±2.1)years old.The bladder neck atresia and urethral obliteration length was 1-2 cm determined by urethrography.Eight cases suffered ureteral strictures after gynecological myomectomy or ureteroscopy holmium laser lithotripsy(4 cases of each type),including two males and six females,with the age of(55.0+3.2)years old.The length of ureteral stricture or defect was 5-6 cm determined by intravenous urography(IVU)or CT urography(CTU).The patients with bladder neck obstruction underwent the following surgery:The"Y"incision of the bladder and stenosis of the prostate urethra was performed and the pedicled bladder muscle flap was inserted into the normal urethral mucosa to complete the Y-V plasty.In the 6 girl patients,pedicled bladder muscle flap(2-4 cm)augmented reconstruction were performed.All above 18 patients,whose urethral catheter was indwelled for 3-4 weeks,urinary flow rate and urethroscopy examination were performed to evaluate the effect of surgery 4 weeks and 3 months after the operation.As the 8 cases with ureteral strictures,the pedicled bladder muscle flap(7-8 cm)ureteroplasty was performed and the ureteral stent was retained for 4 weeks.Ultrasonography and IVU/CTU were performed 4 weeks and 3 months postoperatively.The patency of the

关 键 词：输尿管梗阻 膀胱颈部梗阻 尿道梗阻 膀胱肌瓣 修复重建 

分 类 号：R699[医药卫生—泌尿科学]