Armatys Sandra A, Mellon Matthew J, Beck Stephen D W, Koch Michael O, Foster Richard S, Bihrle Richard
Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Urol. 2009 Jan;181(1):177-81. doi: 10.1016/j.juro.2008.09.019. Epub 2008 Nov 14.
We reviewed indications and outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction.
Between December 1989 and September 2007, 105 patients underwent ileal ureter replacement, of whom 14 were excluded from study due to incomplete data. The remaining 91 patients (99 renal units) comprised the study cohort.
Mean patient age was 46.8 years and mean followup was 36.0 months. Indications for an ileal ureter were stricture following genitourinary surgery in 29 cases (31.9%), radiation induced stricture in 17 (18.7%), nonurological surgery iatrogenic injury in 16 (17.6%) and retroperitoneal fibrosis in 11 (12.1%). Only 4 patients (4.4%) had primary ureteral cancer. Long-term complications included anastomotic stricture in 3 patients (3.3%) and fistula in 6 (6.6%). Serum creatinine decreased or remained stable in 68 patients (74.7%) and hyperchloremic metabolic acidosis developed in 3. No patient complained of excessive urinary mucous production.
In 68.1% of patients indications for an ileal ureter included radiation induced stricture or iatrogenic injury. The ileal ureter is a reasonable option for long-term ureteral reconstruction with preserved renal function in carefully selected patients.
我们回顾了接受回肠代输尿管进行输尿管重建患者的适应证及治疗结果。
1989年12月至2007年9月期间，105例患者接受了回肠代输尿管手术，其中14例因数据不完整被排除在研究之外。其余91例患者（99个肾单位）组成了研究队列。
患者平均年龄为46.8岁，平均随访时间为36.0个月。回肠代输尿管的适应证包括：泌尿生殖系统手术后狭窄29例（31.9%），放射性狭窄17例（18.7%），非泌尿外科手术医源性损伤16例（17.6%），腹膜后纤维化11例（12.1%）。仅4例患者（4.4%）患有原发性输尿管癌。长期并发症包括吻合口狭窄3例（3.3%），瘘管形成6例（6.6%）。68例患者（74.7%）血清肌酐下降或保持稳定，3例患者发生高氯性代谢性酸中毒。无患者主诉尿液黏液分泌过多。
68.1%的患者回肠代输尿管的适应证包括放射性狭窄或医源性损伤。对于经过精心挑选的患者，回肠代输尿管是保留肾功能的长期输尿管重建的合理选择。
