摘要
目的 探讨经尿道膀胱电切术中丢失输尿管开口后寻找输尿管开口及留置输尿管支架管（双J管）的处理技巧和安全性.方法 回顾性分析2010年1月至2016年8月收治的累及输尿管口的非肌层浸润性膀胱肿瘤患者42例及腺性膀胱炎患者18例,男44例,女16例.年龄32 ～81岁,平均55岁.其中膀胱肿瘤患者单发23例,多发19例,初发37例,复发5例.膀胱肿瘤及腺性膀胱炎患者术前影像学检查证实输尿管均无扩张、积水.60例均行经尿道膀胱电切术,切除范围达深肌层,其中膀胱肿瘤患者均将患侧输尿管口完全切除,腺性膀胱炎患者切除输尿管口18例,术中切除输尿管开口后,在寻找输尿管开口的时候,循输尿管蠕动走行的方向逐层电切,寻及“同心圆”样改变肌层组织后使用斑马导丝作为指引寻找输尿管黏膜,循斑马导丝置入F6双J管.60例患者术毕均于切除输尿管口侧留置双J管1根.所有患者术后即可膀胱内灌注吡柔比星50 mg,后根据病理结果制定膀胱灌注化疗方案.术后8～10周行膀胱镜下拔除双J管术,术后每3个月复查一次.结果 60例手术均顺利完成,无手术并发症.术后膀胱灌注化疗过程中均未见严重不良反应.随访4 ~60个月,60例留置双J管者均未发生肾积水或输尿管狭窄,复查膀胱镜见输尿管开口呈电切术后改变,喷尿正常,均无膀胱输尿管反流症状.结论 经尿道电切术治疗累及输尿管口的非肌层浸润性膀胱肿瘤及腺性膀胱炎的过程中,常常因病情需要需切除输尿管开口,循输尿管蠕动走行方向寻找输尿管开口方法确切,留置双J管可减少术后输尿管狭窄的发生率,且不会增加肿瘤细胞逆行种植的风险.
Objective To evaluate the processing techniques and safety of ureteral stent after transurethral resection （TUR） of bladder lesions involving the ureteral orifice.Methods From January 2010 to August 2016,42 cases of non-muscle invasive bladder tumor and 18 cases of glandular cystitis including 44 male and 16 female aged from 32 to 81 years（mean 55 years） were treated by TUR.Twenty-three cases of bladder tumor had single tumor and 19 cases had multiple tumors,and 37 cases were primary and 5 cases were recurrent.All the patients without preoperative hydronephrosis revealed by imageological examination.The lesions were resected into the deep muscle layer and involved ureteral orifice were resected during the procedure and after that a Double-J ureteral stent was placed in all cases.When looked for the ureteral orifice,we followed the ureteral peristalsis step by step,and found ＂concentric circles＂ muscle tissue.Then we used the guide wire as a guide for ureteral stenting.All the patients received one immediate intravesical instillation of 50 mg pirarubicin after TUR,and further scheme of adjuvant intravesical instillation was made according to the pathological diagnosis.Ureteral stents were removed 8 ～ 10 weeks after TUR,imageological examination were performed every three months.Results The operations were successful without complications.No serious adverse reaction occurred in adjuvant intravesical instillation chemotherapy.During the follow-up period of 4 ～ 60 months,no ureteral stricture and hydronephrosis occurred in all patients with ureteral stent,and the resected ureteral orifices recovered well with normal appearance and ejecting urine.Conclusions The ureteral orifice usually need to be removed during TUR for bladder lesions,and the way we following the ureteral peristalsis to resect the ureteral orifice is effective.Ureteral stenting after TUR of bladder lesions involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract.
出处
《国际泌尿系统杂志》
2018年第1期102-105,共4页
International Journal of Urology and Nephrology
