Geavlete P, Mulţescu R, Jecu M, Georgescu D, Geavlete B
Clinica de Urologie, Spitalul Clinic de Urgentă Sf. Ioan, Bucureşti, România.
Chirurgia (Bucur). 2009 Nov-Dec;104(6):731-6.
Uretero-enteric stenosis may raise some specific problems due to difficulties concerning the retrograde access. The aim of our study was to evaluate the effectiveness of antegrade flexible ureteroscopic approach for this specific pathology.
Between January 2002 and June 2008, a number of 7 patients underwent antegrade flexible ureteroscopy for uretero-enteric stenosis: 3 patients with stenosis of the uretero-neobladder anastomosis (Group I), 2 patients with stenosis of the uretero-sigmoidian implantation (Group II) and 2 patients with stenosis of the ureteral implantation in an ileal conduit (Group III). In Group I, we performed antegrade Nd:YAG laser star incision in 2 cases and balloon dilation in 1 case. In Group II, the antegrade Nd:YAG laser star incision was applied in 1 case and balloon dilation was performed in the other one. In Group III, we performed antegrade insertion of the guidewire followed by retrograde cold-knife incision in one case, and bipolar ureteral approach (cut-to-the-light technique) in 1 case.
The mean operative time was 58 min. (range 25 to 120 min). We didn't describe major intraoperative complications. Ultrasonography, IVP and isotopic renogram (in selected cases) have been the follow-up evaluation methods. Postoperatively, 2 cases from Group I and all cases from Groups II and III had a good evolution, with significant reduction of the hydronephrosis degree at 6, 12 and 18 months. One patient from Group I, in which balloon dilation of the stenosis was performed, developed recurrence at 6 months.
According to our experience, antegrade flexible ureteroscopic approach may represent an efficient and safe technique in uretero-enteric stenosis treatment. Being a minimally invasive approach, this procedure has a reduced rate of complications and good anatomical and functional results.
由于逆行通路存在困难，输尿管肠吻合口狭窄可能引发一些特定问题。我们研究的目的是评估顺行性软性输尿管镜检查方法对这种特定病理情况的有效性。
2002年1月至2008年6月期间，7例患者因输尿管肠吻合口狭窄接受了顺行性软性输尿管镜检查：3例输尿管新膀胱吻合口狭窄患者（第一组），2例输尿管乙状结肠植入处狭窄患者（第二组），2例输尿管在回肠代膀胱植入处狭窄患者（第三组）。在第一组中，2例患者进行了顺行性钕：钇铝石榴石激光星形切开，1例患者进行了球囊扩张。在第二组中，1例患者应用了顺行性钕：钇铝石榴石激光星形切开，另一例患者进行了球囊扩张。在第三组中，1例患者进行了顺行性导丝插入，随后进行了逆行冷刀切开，另1例患者采用了双极输尿管入路（透光技术）。
平均手术时间为58分钟（范围为25至120分钟）。我们未描述主要的术中并发症。超声检查、静脉肾盂造影和同位素肾图（在选定病例中）为随访评估方法。术后，第一组的2例患者以及第二组和第三组的所有患者病情进展良好，在6个月、12个月和18个月时肾积水程度显著减轻。第一组中1例进行了狭窄球囊扩张的患者在6个月时复发。
根据我们的经验，顺行性软性输尿管镜检查方法可能是治疗输尿管肠吻合口狭窄的一种有效且安全的技术。作为一种微创方法，该手术并发症发生率较低，且具有良好的解剖和功能效果。
