肠代输尿管术治疗输尿管长段狭窄的应用经验和临床疗效  

The experience and clinical efficacy of intestinal ureteral replacement for the treatment of long segment ureteral stenosis

作　　者：王振兴[1] 杨昆林 赵杨 梁超启 周亮[5] 包军胜[6] 李学松[2] 周辉霞 李兵[4] 王坤杰[5] 罗光恒 Wang Zhenxing;Yang Kunlin;Zhao Yang;Liang Chaoqi;Zhou Liang;Bao Junsheng;Li Xuesong;Zhou Huixia;Li Bing;Wang Kunjie;Luo Guangheng(Department of Urology,Guizhou Provincial People's Hospital,Guiyang 550001,China;Department of Urology,First Hospital of Peking University,Bejing,100034,China;Department of Urology,Sventh Medical Center,General Hospital of the people's Liberation Army,Bejing,100700,China;Department of Urology,Union Hospital,Huazhong University of Science and Technology,Wuhan,430030,China;Department of Urology,West China Hospital,Sichuan University,Chengdu,610041,China;Department of Urology,Second Hospital,Lanzhou University,Lanzhou,730030,China)

机构地区：[1]贵州省人民医院泌尿外科,贵阳550001 [2]北京大学第一医院泌尿外科,北京100034 [3]解放军总医院第七医学中心泌尿外科,北京100700 [4]华中科技大学同济医学院附属协和医院泌尿外科,武汉430030 [5]四川大学华西医院泌尿外科,成都610041 [6]兰州大学第二医院泌尿外科,兰州730030

出　　处：《中华泌尿外科杂志》2024年第2期91-97,共7页Chinese Journal of Urology

摘　　要：目的总结在上尿路修复和重建中应用肠道的经验, 探讨肠代输尿管术的临床疗效。方法回顾性分析2016年6月至2021年12月贵州省人民医院、北京大学第一医院、解放军总医院第七医学中心、华中科技大学同济医学院附属协和医院、四川大学华西医院、兰州大学第二医院收治的138例长段输尿管狭窄患者的病例资料, 男66例, 女72例。年龄(35.54±21.35)岁, 其中儿童9例, 年龄(10.78±4.41)岁。输尿管狭窄位于左侧65例, 右侧38例, 双侧34例。孤立肾12例。输尿管上段狭窄26例, 中段狭窄2例, 下段狭窄24例。输尿管全长狭窄14例, 输尿管多发狭窄54例。术前留置肾造瘘管22例, 留置双J管88例。术前行B超、增强CT、CTU、MRU、顺行和逆行造影检查测量输尿管狭窄长度为(15.93±4.67)cm。术前血肌酐(93.94±37.13)μmol/L, 尿素氮(5.91±1.99)mmol/L, 估算肾小球滤过率(eGFR)(83.53±25.18)ml/min。孤立肾患者术前血肌酐(104.83±69.14)mol/L, 尿素氮(7.33±2.90)mmol/L, eGFR(64.53±14.46)ml/min。本研究138例, 接受回肠代输尿管术(回肠组)123例, 术中测量输尿管狭窄长度(14.48±6.28)cm, 选取回肠段长度(20.67±11.20)cm, 替代输尿管长度(22.97±8.09)cm;Yang-Monti回肠代输尿管术(Yang-Monti回肠组)7例, 术中测量输尿管狭窄长度(15.43±4.35)cm, 截取回肠段(3.00±0.58)段, 每段回肠段长度2.5~3.0 cm, 重建回肠段长度(16.83±3.97)cm, 重建回肠替代输尿管长度(11.50±5.65)cm;Yang-Monti结肠代输尿管术(Yang-Monti结肠组)8例, 术中测量输尿管狭窄长度(6.00±0.93)cm, 截取结肠段(2.75±0.46)段, 每段结肠段长度1.5~2.0 cm, 重建结肠段长度(5.13±1.13)cm, 重建结肠替代输尿管长度(4.88±1.46)cm。Yang-Monti回肠组与回肠组术中测量的输尿管狭窄长度比较差异无统计学意义(P=0.6900);Yang-Monti结肠组与回肠组术中测量的输尿管狭窄长度比较差异有统计学意义(P=0.0002);Yang-Monti回肠组(P=0.0001)和Objective To summarize the experience of intestinal tract in repairing and reconstructing upper urinary tract,and to explore the clinical efficacy of intestinal ureter replacement.Methods From June 2016 to December 2021,a total of 138 patients(66 men and 72 women,129 adults and 9 children)with a mean age of(35.54±21.35)years[(10.78±4.41)years in 9 children aged of 4-16 years]were diagnosed as long segmental ureteral stenosis and underwent ureteral reimplantation using ileal or colonic segments in six tertiary A class hospitals in China.Of the 138 patients,65,38,and 34 stenosis presented in left,right or both sides,and 26,2,and 24 stenosis located in upper,middle or lower ureter,respectively.Full length and multi-segmental stenosis occurred in 14 and 54 patients respectively.There were 12 stenosis presented in solitary kidney,and 22 patients undergoing nephrostomy and another 88 cases undergoing double J stenting.Length of stenosis ranged from 9 to 25cm[mean(15.93±4.67)cm]measured by ultrasound,enhanced CT,CTU,MRU,or anterograde/retrograde pyelography.Baseline creatinine,BUN and eGFR were(93.94±37.13)μmol/L,(5.91±1.99)mmol/L and(83.53±25.18)ml/min respectively,while in patients with solitary kidney,they were(104.83±69.14)mol/L,(7.33±2.90)mmol/L and(64.53±14.46)ml/min respectively.This study involved 138 cases,including 123 patients undergoing ileal ureter with mean stenosis length of(14.48±6.28)cm by intraoperative measurement.The mean(20.67±11.20)cm of ileal segment was taken to replace the mean(22.97±8.09)cm of ureteral defect.Yang-Monti ileal ureter was adopted in 7 patients with stenosis of mean(15.43±4.35)cm.Ileal segments of(16.83±3.97)cm were further divided into 2 to 4(mean 3.00±0.58)sub-segments,2.5 to 3cm each,and reconstructed ileal ureter of mean(11.50±5.65)cm.Eight patients undwewent Yang-Monti colonic ureter and the mean stenosis length was(6.00±0.93)cm.The mean(5.13±1.13)cm of colonic segment was taken and divided into 2 to 3 segments(mean 2.75±0.46 segments,1.5 to 2.0 cm each)an

关 键 词：输尿管疾病 Yang-Monti 回肠代输尿管 结肠代输尿管 长段输尿管狭窄 

分 类 号：R699.4[医药卫生—泌尿科学]