Martínez-Sagarra J M, Amón Sesmero J H, Santos Largo J, Estébanez Zarranz J, Amo Garcia A, Rodríguez Toves A
Servicio de Urología, Hospital Río Hortega, Valladolid, España.
Arch Esp Urol. 1992 Nov;45(9):961-6.
When the ureter is extensively compromised, preservation of the kidney without recurring to external diversion may be attempted by a psoas bladder procedure, transureteroureterostomy, renal autotransplantation or ureteral substitution using the intestine. The first two are not always possible and transplantation is perhaps extremely disproportionate. We therefore recur to ureteral substitution using the intestine. Ureteral substitution may be partial or total, although it is recommended to preserve the upper segment of the lumbar ureter whenever possible. The procedure can be performed using the entire ileal segment with or without modelling to the appropriate thickness. Reducing the diameter of the ileal graft will enhance urine propulsion, reduce mucus secretion and improve antireflux dynamics. Nine cases of ureteral substitution are described herein. Treatment depended on the underlying pathology, extent of ureteral compromise and location. The techniques employed were ureteral substitution with or without modelling and ureteral substitution combined with a bladder repair procedure.
当输尿管受到广泛损害时，可尝试通过腰大肌膀胱手术、输尿管-输尿管吻合术、自体肾移植或使用肠道进行输尿管替代来保留肾脏而不进行外部改道。前两种方法并非总是可行，且移植可能极不相称。因此，我们采用使用肠道进行输尿管替代。输尿管替代可部分或全部进行，不过建议尽可能保留腰段输尿管的上段。该手术可使用整个回肠段，可进行塑形也可不进行塑形至合适厚度。减小回肠移植物的直径将增强尿液推进力、减少黏液分泌并改善抗反流动力学。本文描述了9例输尿管替代病例。治疗取决于潜在病理状况、输尿管损害程度及位置。所采用的技术包括有或无塑形的输尿管替代以及输尿管替代联合膀胱修复手术。
