Ben Slama Mohamed Riadh, Zaafrani Ridha, Ben Mouelli Sami, Derouich Amine, Chebil Mohamed, Ayed Mohsen
Service d'Urologie, Hôpital Charles Nicolle, Tunis, Tunisie.
Prog Urol. 2005 Sep;15(4):646-9.
Iatrogenic stenoses of the ureteropelvic junction are now essentially treated by endoscopic techniques. However, conventional surgery is sometimes required to treat severe or extensive stenosis. The authors report the use of ureterocalicostomy to treat 5 patients with complex lesions.
Between 2001 and 2003, the authors treated five patients with iatrogenic stenosis of the ureteropelvic junction. Two of these patients had a history of percutaneous nephrolithotomy and the other three had undergone conventional pyelotomy, complicated by pyelocaliceal avulsion in one case. The diagnosis was confirmed by double anterograde and retrograde opacification in four patients and intravenous urography in one patient. It was decided to perform ureterocalicostomy due to the extent of the lesions. Inferior ureterocalicostomy was performed after lower pole nephrectomy in all cases.
The mean follow-up was 21 months (range: 20 to 27 months). Three patients had an uneventful postoperative course and satisfactory radiological follow-up. One patient rapidly developed stenosis that was treated successfully by endoscopy and another patient obtained a poor result requiring nephrectomy.
Ureterocalicostomy requires laborious surgical dissection and meticulous ureterocaliceal anastomosis, but it is a useful technique in some cases of severe and extensive iatrogenic stenosis of the ureteropelvic junction.
输尿管肾盂连接处医源性狭窄目前主要通过内镜技术治疗。然而，对于严重或广泛的狭窄有时需要进行传统手术。本文作者报道了采用输尿管肾盂造口术治疗5例复杂病变患者的情况。
2001年至2003年间，作者治疗了5例输尿管肾盂连接处医源性狭窄患者。其中2例有经皮肾镜取石术病史，另外3例接受了传统肾盂切开术，1例并发肾盂肾盏撕裂伤。4例患者通过顺行和逆行双重造影确诊，1例通过静脉肾盂造影确诊。由于病变范围，决定行输尿管肾盂造口术。所有病例均在切除下极肾后行低位输尿管肾盂造口术。
平均随访21个月（范围：20至27个月）。3例患者术后病程顺利，影像学随访结果满意。1例患者迅速出现狭窄，经内镜成功治疗，另1例患者效果不佳，需行肾切除术。
输尿管肾盂造口术需要进行繁琐的手术解剖和细致的输尿管肾盂吻合，但在某些严重和广泛的输尿管肾盂连接处医源性狭窄病例中是一种有用的技术。
