Milhoua Paul M, Miller Nicole L, Cookson Michael S, Chang Sam S, Smith Joseph A, Herrell S Duke
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
J Endourol. 2009 Mar;23(3):551-5. doi: 10.1089/end.2008.0230.
To review our institutional experience in the management of ureteroenteric strictures by primary endoscopic intervention or primary open revision.
Between January 2000 and December 2007, 28 patients with ureteroenteric strictures underwent endoscopic management (n = 21) or open revision (n = 7). Strictures were characterized with regard to length and side as well as time to failure between the two groups. Success was defined as symptomatic improvement and evidence of patency on follow-up radiologic imaging.
Of all study patients, 78.6% were symptomatic on presentation. Endoscopic intervention (balloon dilation, electroincision, or holmium endoureterotomy) was successful in six patients for an overall success rate of 27% with a median follow-up of 21 months. Open revision was successful in 87.5% (7 of 8) patients for whom initial endoscopic surgery had failed. The success rate of primary open revision was 71.4% (5 of 7 patients) with a mean follow-up of 18.1 months. For the entire series, left-sided strictures were more common than right sided strictures; however, side and stricture length were not found to be significant (P > 0.05) with regard to patency. Functional renal imaging studies were performed in 42.9% of all study patients postoperatively.
Endoscopic management continues to have success rates that remain lower than that of open revision. Left-sided strictures remain more common than right-sided strictures; however, side and stricture length were not found to be statistically significant in our series. The lack of consistent postoperative functional renal studies highlights the importance of diligent monitoring and warrants further study to develop a surveillance algorithm.
回顾我们机构通过初次内镜干预或初次开放修复治疗输尿管肠吻合口狭窄的经验。
2000年1月至2007年12月期间，28例输尿管肠吻合口狭窄患者接受了内镜治疗（n = 21）或开放修复（n = 7）。对狭窄的长度、部位以及两组之间的失败时间进行了特征描述。成功定义为症状改善以及随访影像学检查显示通畅。
所有研究患者中，78.6%在就诊时有症状。内镜干预（球囊扩张、电切或钬激光输尿管内切开术）在6例患者中成功，总体成功率为27%，中位随访时间为21个月。初次内镜手术失败的患者中，开放修复的成功率为87.5%（8例中的7例）。初次开放修复的成功率为71.4%（7例患者中的5例），平均随访时间为18.1个月。在整个系列中，左侧狭窄比右侧狭窄更常见；然而，就通畅情况而言，部位和狭窄长度无显著差异（P > 0.05）。所有研究患者中42.9%术后进行了功能性肾脏影像学检查。
内镜治疗的成功率仍然低于开放修复。左侧狭窄比右侧狭窄更常见；然而，在我们的系列研究中，部位和狭窄长度无统计学意义。术后缺乏一致的功能性肾脏研究凸显了密切监测的重要性，并需要进一步研究以制定监测算法。
