摘要
目的探讨回肠代输尿管联合膀胱扩大术治疗输尿管长段梗阻合并膀胱挛缩的安全性、有效性。方法回顾性分析2015年8月至2018年11月收治的3例输尿管长段梗阻合并膀胱挛缩患者的临床资料。男1例,女2例。年龄34~55岁,平均39岁。2例为泌尿系结核致左输尿管长段狭窄及膀胱挛缩,1例为宫颈癌放疗后双侧输尿管狭窄合并膀胱容量减少。术前输尿管缺损长度6~18 cm,平均9.8 cm;术前泌尿系超声检查示膀胱容量60~150 ml,平均103.3 ml。3例均行回肠代输尿管联合膀胱扩大术,1例为腹腔镜手术,2例为开放手术,术中利用回肠替代输尿管,回肠远端"U"形折叠扩大膀胱。结果3例手术均顺利完成,手术时间220~400 min,平均303.0 min;出血量150~500 ml,平均283.3 ml。术后随访时间6~36个月,平均16个月。术后3周膀胱造影检查示膀胱容量300~400 ml,平均360.0 ml;术后3个月泌尿系超声检查示残余尿量20~50 ml,平均33.3 ml。随访过程中患者尿频、尿急完全缓解1例,较术前减轻2例;腰痛完全缓解1例,较术前减轻2例。1例出现尿路感染,予抗生素治疗后痊愈。1例出现轻度代谢性酸中毒,予口服碳酸氢钠纠正。末次随访2例血肌酐轻度升高,1例肾功能正常。结论回肠代输尿管联合膀胱扩大术可以同时解除输尿管长段梗阻并提高膀胱容量,但患者术后需定期复查,监测并发症与肾功能变化。
Objective To explore the availability and safety of ileal ureter replacement combined with ileal augmentation cystoplasty in treating ureteral stenosis with contracted bladder.Methods From August 2015 to November 2018,three patients who underwent ileal ureter replacement combined with augmentation cystoplasty were treated with ileal ureter replacement combined with augmentation cystoplasty.There were 1 male and 2 females with the age ranging from 34 to 55 years(mean 39 years).Two patients suffered from left ureter stenosis,and one patient had stenosis on the both sides.The length of the ureter stenosis ranged from 6 to 18 cm(mean 9.8 cm).The preoperative bladder capacity ranged from 60 to 150 ml(mean 103.3 ml).In the surgery,part of ileum was used to replace the ureter,and the distal intestine was made into U-shape to enlarge the bladder.Results All operation were completed successfully.The operation time ranged from 220 to 400 min(mean 303.0 min),and the blood loss ranged from 150 to 500 ml(mean 283.3 ml).Laparoscopic surgery was performed in 1 case and open surgery in 2 cases.Three weeks after the surgery,the bladder volume underwent cystography ranged from 300 to 400 ml(mean 360.0 ml).Three months after the surgery,the postvoid residual urine volume ranged from 20 to 50 ml(mean 33.3 ml).Postoperative frequency and urgency of urine were completely relieved in 1 case,alleviated in 2 cases.Flank pain was completely relieved in 1 case,and alleviated in 2 cases postoperatively.The serum creatinine of 2 patients mildly increased after the surgery,while 1 patient remained stable.For complications,1 patient had urinary infection,and 1 patient suffered from metabolic acidosis.Conclusions Ileal ureteral replacement combined with augmentation cystoplasty can be the choice of treatment for long segment ureteral stenosis and enlarge the bladder simultaneously.The postoperative complications and the kidney functions should be regularly followed up.
作者
杨昆霖
吴昱晔
丁光璞
蔡宇坤
石玮
包军胜
关文峰
李子奡
樊书菠
李万强
张雷
李学松
周利群
Yang Kunlin;Wu Yuye;Ding Guangpu;Cai Yukun;Shi Wei;Bao Junsheng;Guan Wenfeng;Li Zi′ao;Fan Shubo;Li Wanqiang;Zhang Lei;Li Xuesong;Zhou Liqun(Department of Urology,Peking University First Hospital,Beijing 100034,China;Department of Urology,the Second People’s Hospital of Fujian,Fuzhou 350003,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第6期416-421,共6页
Chinese Journal of Urology
关键词
膀胱扩大术
肠代输尿管
泌尿系结核
输尿管狭窄
Augmentation cystoplasty
Ileal ureter replacement
Ureteral obstruction
Urinary tuberculosis
