Paick Jae-Seung, Hong Sung Kyu, Park Moon-Soo, Kim Soo Woong
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Urology. 2006 Feb;67(2):237-41. doi: 10.1016/j.urology.2005.08.041. Epub 2006 Jan 25.
To reevaluate the role of ureteroureterostomy in the management of postoperatively detected iatrogenic lower ureteral injury. Despite the advantages of preserving the integrity of bladder and the natural antireflux mechanism, open end-to-end ureteroureterostomy is rarely performed today for treatment of lower ureteral injury diagnosed postoperatively.
A retrospective analysis was performed of 9 patients (all women, mean age 49.2 years) who had received end-to-end ureteroureterostomy from 1998 to 2002 for postoperatively detected iatrogenic lower ureteral injuries sustained during gynecologic or general surgery.
All patients had the intact distal ureteral stumps identified by retrograde pyelography before undergoing ureteroureterostomy. Open end-to-end ureteroureterostomies with double-J catheter stenting were performed as soon as the diagnosis had been made (interval from injury to repair 10 days to 21 weeks). The mean length of the eventually resected segments of the injured lower ureter was 2.7 cm, and the mean distance between the distal margin of the injured ureteral segment and the ureterovesical junction measured intraoperatively was 2.9 cm. Renal mobilization was required in 1 patient. In 1 patient who had a bilateral ureteral injury, ureteroureterostomy was performed on only one side, with a psoas hitch on the contralateral side. In all cases, the initially observed hydronephrosis and fistula disappeared after surgery, and no complications were observed during a mean follow-up of 33.7 months (range 6 to 55).
Ureteroureterostomy may still be considered a realistic treatment option in the case of postoperatively detected iatrogenic lower ureteral injuries with distal ureteral stumps preserved and identified on retrograde pyelography.
重新评估输尿管输尿管吻合术在处理术后发现的医源性下段输尿管损伤中的作用。尽管保留膀胱完整性及天然抗反流机制有诸多优点，但如今开放性端端输尿管输尿管吻合术很少用于治疗术后诊断的下段输尿管损伤。
对1998年至2002年间因妇科或普通外科手术中发生的医源性下段输尿管损伤而接受端端输尿管输尿管吻合术的9例患者（均为女性，平均年龄49.2岁）进行回顾性分析。
所有患者在接受输尿管输尿管吻合术前经逆行肾盂造影确定远端输尿管残端完整。一旦确诊，即行开放性端端输尿管输尿管吻合术并置入双J导管支架（从损伤到修复的间隔时间为10天至21周）。最终切除的损伤下段输尿管节段平均长度为2.7 cm，术中测量损伤输尿管节段远端边缘与输尿管膀胱连接处的平均距离为2.9 cm。1例患者需要游离肾脏。1例双侧输尿管损伤患者仅在一侧行输尿管输尿管吻合术，对侧行腰大肌悬吊术。所有病例术后最初观察到的肾积水和瘘管均消失，平均随访33.7个月（6至55个月）期间未观察到并发症。
对于术后发现的医源性下段输尿管损伤且逆行肾盂造影显示远端输尿管残端保留并可识别的情况，输尿管输尿管吻合术仍可被视为一种切实可行的治疗选择。
