顺行输尿管软镜钬激光切开治疗根治性膀胱切除术后输尿管-肠吻合口狭窄

徐刚; 虞力航; 阎家骏; 潘寿华

doi:10.13201/j.issn.1001-1420.2019.06.015

顺行输尿管软镜钬激光切开治疗根治性膀胱切除术后输尿管-肠吻合口狭窄

- 绍兴市人民医院(浙江大学绍兴医院)泌尿外科 (浙江绍兴, 312000)

详细信息

通讯作者: 虞力航,E-mail:493658370@qq.com

中图分类号: R693

收稿日期: 2017-11-22

Antegrade flexible ureteroscopic incision with holmium laser in the management of ureterointestinal anastomotic strictures after radical cystectomy

- Department of Urology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, 312000, China

More Information

Corresponding author: YU Lihang, E-mail: 493658370@qq.com

Received Date: 22 November 2017

摘要

摘要: 目的:通过回顾性分析6例根治性膀胱切除术后输尿管-肠吻合口狭窄患者的临床资料,探讨输尿管软镜下钬激光内切开术治疗输尿管-肠吻合口狭窄的可行性及临床价值。方法:收集2013年4月~2016年12月因根治性膀胱切除术后输尿管-肠吻合口狭窄患者6例,其中左侧4例(包括左侧孤立肾1例),右侧2例;年龄57~76岁,平均67.5岁;术后至诊断狭窄时间为7~23个月,平均14.2个月;狭窄长度0.7~2.0 cm,平均1.2 cm,合并肾功能不全1例,吻合口结石伴肾盂积脓1例;4例在一期行经皮肾穿刺造瘘加输尿管软镜下钬激光内切开术,2例先行造瘘待肾功能及感染好转后二期行内切开治疗,手术充分切开狭窄管壁至外膜脂肪组织,合并结石者一并钬激光碎石处理,术后放置2根F6单J管12周。结果:平均手术时间52.8 min,术中无明显出血、漏尿及损伤周围相邻组织等并发症发生,术后平均住院时间4.3 d,随访11~55个月,1例长段狭窄患者于术后5个月再发狭窄,予定期更换单J管,其余5例无再发狭窄。结论:顺行输尿管软镜下结合钬激光内切开术治疗输尿管-肠吻合口狭窄是一种简便、安全及较为有效的治疗方法,值得临床推广。
- 顺行输尿管软镜 /
- 钬激光 /
- 输尿管-肠吻合口狭窄
Abstract: Objective: To assess the feasibility and clinical efficacy of antegrade flexible ureteroscopic incision with holmium laser in the management of ureterointestinal anastomotic strictures after radical cystectomy by a retrospective analysis of 6 cases. Method: From April 2013 to December 2016, 6 patients with ureterointestinal anastomotic stricture after radical cystectomy were enrolled in the study. Among the 6 cases, 4 cases are on the left (including a solitary kidney), 2 cases are on the right. The average age of the patients was 67.5 years old. The first clinic presentation was 14.2 months after radical cystectomy (7-23 months). The average length of stricture was 1.2 (0.7-2.0) cm. There was 1 case with acute renal failure and 1 case with pyonephrosis due to ureterointestinal anastomotic calculus. Four cases underwent percutaneous nephrostomy and antegrade flexible ureteroscopic incision simultaneously. Simple nephrostomic drainage was carried out for 2 cases at first. Then second stage operation of antegrade flexible ureteroscopic incision was performed after the renal function and infection improved. During the surgery, the ureteral wall should be fully incised to the outer adipose tissue, meanwhile, the ureteral calculi should be cleared by holmium laser lithotripsy, two F6 single J ureter stent should be maitained for 12 weeks after surgery. Result: The average operation time was 52.8 min, without complication of hemorrhage, leakage of urine, injuries of adjacent tissue, etc. The average length of stay was 4.3 days. During the follow-up period of 11-55 months, one case with long lenth of stricture recurred after 5 months, while other 5 cases were recurrence-free.Conclusion: The antegrade flexible ureteroscopic incision in the management of ureterointestinal anastomotic strictures is a convenient, safe and effective therapeutic method, and worth clinic application.
- antegrade flexible ureteroscope /
- holmium /
- YAG laser

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