医源性输尿管狭窄68例诊治分析  

Analysis of the diagnosis and treatment of 68 cases of iatrogenic ureteral stricture

作　　者：张鹏 黄炳伟 殷桂草 郑生旗 李喆 乔硕[3] 李学松[4] ZHANG Peng;HUANG Bingwei;YIN Guicao;ZHENG Shengqi;LI Zhe;QIAO Shuo;LI Xuesong(Department of Urology,Emergency General Hospital,Beijing 100028;Department of Urology,Affiliated Hospital of Yangzhou University,Yangzhou 225000;The First Department of Surgery,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102;Department of Urology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]应急总医院泌尿外科,北京100028 [2]扬州大学附属医院泌尿外科,江苏扬州225000 [3]中国中医科学院望京医院外一科,北京100102 [4]北京大学第一医院泌尿外科,北京100034

出　　处：《现代泌尿外科杂志》2023年第7期613-618,共6页Journal of Modern Urology

摘　　要：目的探讨医源性输尿管狭窄的常见病因、特点及治疗。方法回顾性分析2019年5月-2022年3月北京应急总医院226例输尿管狭窄修复患者的临床资料,其中医源性输尿管狭窄患者68例。根据医源性输尿管狭窄的病因,将患者分为泌尿系组及非泌尿系组。结果所有患者中女性42例,男性26例,年龄25.0~67.0岁,平均(49.0±10.4)岁。输尿管上段狭窄24(35.3%)例,中段狭窄12(17.6%)例,下段狭窄24(35.3%)例,全长狭窄8(11.8%)例。在上段输尿管狭窄的治疗中,最常应用口腔黏膜修补输尿管术(9例,13.23%);在中段输尿管狭窄的治疗中,最常应用回肠代输尿管术(5例,7.35%);在下段输尿管狭窄的治疗中,最常应用膀胱壁瓣输尿管成形术(12例,17.65%)。输尿管全长狭窄患者8例均采用了回肠代输尿管术。泌尿系组和非泌尿系组患者在年龄、性别、狭窄侧、狭窄部位和长度、手术方式及手术术型差异均有统计学意义(P<0.05)。术后随访8.0~20.0个月,平均(12.3±5.6)个月,所有患者症状及肾功能均得到改善,未出现输尿管再狭窄。结论侵入性腔内泌尿外科手术是医源性输尿管狭窄的主要病因。应根据患者病情、诊断时间及输尿管损伤的位置和长度采取不同的治疗策略。Objective To investigate the common etiology,characteristics and treatment of iatrogenic ureteral stricture.Methods The clinical data of 226 patients with ureteral stricture repaired during May 2019 and Mar.2022 were retrospectively analyzed,including 68 cases of iatrogenic ureteral stricture.According to the etiology,the patients were divided into urinary group and non-urinary group.Results There were 42 females and 26 males,aged 25 to 67(average 49.0±10.4)years.Upper ureteral stricture was detected in 24(35.3%)cases,who received oral mucosal repair of the ureter.Middle ureteral stricture was detected in 12(17.6%)cases,who underwent ileal ureterography.Lower ureteral stricture was observed in 24(35.3%)cases,who were treated with vesical wall flap ureteroplasty.Full-length stricture was observed in 8(11.8%)cases,who were treated with ileal ureterography.There were significant differences in age,gender,stenosis side,stenosis location and length,surgical methods and types between patients in the urinary group and non-urinary group(P<0.05).During the follow-up of 8 to 20(average 12.3±5.6)months,the symptoms and renal function of all patients improved,and no recurrence occurred.Conclusion Invasive endourological surgery is the most common cause of iatrogenic ureteral stenosis.Different treatment strategies should be adopted according to patients condition,time of diagnosis and location and length of ureteral injury.

关 键 词：输尿管狭窄 医源性损伤 尿路修复 输尿管镜碎石 舌黏膜补片 输尿管成形术 

分 类 号：R692.4[医药卫生—泌尿科学]