医源性损伤致输尿管狭窄重建方法和治疗经验的回顾性分析  

Retrospective analysis of reconstruction methods and treatment experience of iatrogenic ureteral stricture

作　　者：刘猛 王营[1] 宋鲁杰[1] 李鸿宾[1] 杨冉星[1] 张楷乐[1] 陈嵘[1] 胡晓勇[1] 撒应龙[1] 傅强[1] LIU Meng;WANG Ying;SONG Lujie;LI Hongbin;YANG Ranxing;ZHANG Kaile;CHEN Rong;HU Xiaoyong;SA Yinglong;FU Qiang(Department of Urology,Shanghai Sixth People's Hospital/Shanghai Dongfang Urological Reconstruction Research Institute,Shanghai,200233,China)

机构地区：[1]上海市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：《临床泌尿外科杂志》2025年第3期206-211,共6页Journal of Clinical Urology

摘　　要：目的:总结并探讨医源性输尿管损伤的手术方法和治疗经验。方法:回顾性分析2010年1月—2021年12月上海市第六人民医院收治的119例医源性输尿管狭窄患者的诊断、治疗及随访预后等资料。119例患者中,泌尿外科手术损伤86例,普外科手术引发12例,妇科手术引发17例,放疗引发4例。所有患者确诊后均接受了积极的手术治疗。结果:术后平均随访17个月,定期行B超、CT等影像学检查,总体手术治疗成功率为82.4%(98/119)。手术方法包括:输尿管端端吻合术46例,输尿管松解术10例,输尿管膀胱再植术18例(其中黏膜下隧道法14例,乳头法4例),舌黏膜输尿管重建术4例,腰大肌悬吊输尿管膀胱再植术14例,回肠代输尿管重建术10例,Boari肌瓣输尿管膀胱再植术17例。随访期间肾积水复发并加重的患者共21例,其余患者随访期间未观察到肾积水进一步加重。结论:医源性输尿管损伤因微创手术开展的日益普及已日趋增多,输尿管成形术治疗医源性输尿管狭窄的成功率较高,应根据狭窄发生时间、部位、长度、肾功能情况选择合适的治疗方法。Objective:To summarize and discuss the surgical methods and treatment experiences of iatrogenic ureteral injury.Methods:A retrospective analysis was conducted on the diagnosis,treatment,and follow-up outcomes of 119 patients with iatrogenic ureteral stricture treated from January 2010 to December 2021.Among these 119 cases,86 were due to urological surgery,12 due to general surgery,17 due to gynecological surgery,and 4 due to radiation therapy.All patients received active surgical treatment after diagnosis.Results:The average postoperative follow-up was 17 months,during which regular imaging examinations such as ultrasound and CT were performed.The overall success rate of surgical treatment was 82.4%(98/119).Surgical methods included:ureteral end-to-end anastomosis in 46 cases,ureterolysis in 10 cases,ureteral bladder reimplantation in 18 cases,mucosal ureteral reconstruction in 4 cases,psoas hitch ureteral bladder reimplantation in 14 cases,ileal interposition ureteral reconstruction in 10 cases,and Boari flap ureteral bladder reimplantation in 17 cases.During follow-up,21 patients experienced recurrence and worsening of hydronephrosis,while no further worsening of hydronephrosis was observed in the remaining patients.Conclusion:Iatrogenic ureteral injuries have become increasingly common with the growing prevalence of minimally invasive surgeries.Ureteroplasty has a high success rate in treating iatrogenic ureteral stricture.Appropriate treatment methods should be chosen based on the time of stricture occurrence,location,length,and renal function.

关 键 词：输尿管狭窄 医源性损伤 手术治疗 修复与重建 

分 类 号：R693.2[医药卫生—泌尿科学]