全膀胱切除术后输尿管梗阻的诊断和微创治疗  

Diagnosis and micro-invasive treatment of ureteral obstruction after complete cystectomy

作　　者：吴海啸[1] 王先道[1] 余谦[1] 吴汉[1] 汪定海[1] 朱再生[1] 

机构地区：[1]浙江省金华市中心医院泌尿外科,321000

出　　处：《中华泌尿外科杂志》2004年第3期180-182,共3页Chinese Journal of Urology

摘　　要：目的　总结全膀胱切除术后输尿管梗阻的诊断和微创处理方法。　方法　全膀胱切除术后输尿管梗阻患者 12例。原发病膀胱肿瘤 10例、结核性小膀胱 1例、放射性膀胱炎 1例。术后输尿管贮尿囊吻合口狭窄 9例、吻合口以上梗阻 3例。均采用MRI和肾镜下肾盂输尿管插管造影诊断。行手术治疗 11例 ,其中镍钛合金记忆金属网支架术 6例 ,输尿管支架术 4例 6侧 ,输尿管贮尿囊吻合术 1例。　结果　 12例均诊断明确。 11例术后随访 3个月～ 5年。IVU示患肾功能恢复正常、肾积水消失 9例 ,肾积水减轻 2例。肌酐及尿素氮正常。 1例膀胱癌患者术后 6个月死于肿瘤肺转移。　结论　MRI和肾镜下的肾盂输尿管插管造影是最有价值的检查手段 ;输尿管支架术、输尿管镍钛记忆合金支架术手术简单、创伤小、效果好。Objective To evaluate the diagnosis and micro-invasive treatment of ureteral obstruction after complete cystectomy. Methods All the 12 patients (primary diseases:10 cases of bladder tumor,1 of small bladder of tuberculosis,1 of radiocystitis;post-operative ureteral obstruction:9 cases of anastomotic stenosis,3 of supra-anastomotic obstruction) underwent MRI and experienced nephroscopic monitoring for diagnosis.Eleven patients underwent surgical treatment.Of them,6 cases received ureter nickel-titanium alloy trestle;4 cases (6 sides),ureter trestle,and 1,ureterocystostomy. Results All the 12 cases were correctly diagnosed.Of them 11 were followed up for 3 months to 5 years.IVU showed normal renal function and complete resolution of hydronephrosis of the diseased kidneys in 9 cases and relief of hydronephrosis in 2.Cr and BUN were normal in all the cases.Only one case of bladder cancer died of lung metastasis. Conclusions Pelviureteroradiography under MRI or nephroscopic monitoring is the most valuable method of examination for ureteral obstruction after complete cystectomy.Surgical ureter trestle and nickel-titanium alloy ureter trestle are simple,micro-invasive and effective for paitens with such post-operative obstruction.

关 键 词：全膀胱切除术 输尿管梗阻 诊断 微创外科 影像学检查 

分 类 号：R699[医药卫生—泌尿科学]