Tsivian Alexander, Tsivian Matvey, Sidi A Ami
Department of Urologic Surgery, The E. Wolfson Medical Center, Holon, Israel.
Can J Urol. 2010 Oct;17(5):5394-6.
Injuries of the upper (lumbar) portion of the ureter are rare; however, their reconstruction may pose considerable challenges. We describe a novel technique of surgical reconstruction in case of a long upper ureteral obliteration that may be a viable treatment option in select patients.
Reconstruction of a iatrogenic 5 cm injury to the upper ureter, consisting of 2 cm obliteration and 1.5 cm stenotic segments on its sides, unsuitable for an end-to-end reanastomosis, was performed using a novel technique of augmented pelvic flap anastomotic ureteroplasty. The injured ureteral segment was excised, the ureteral stump was spatulated on the medial aspect and the lateral tissue defect was replaced by a flap from the posterior surface of the renal pelvis.
The procedure was successfully performed avoiding more aggressive and morbid management choices. To date, patient's renal function is stable and there is no clinical or radiographic evidence of obstruction.
The described augmented anastomotic ureteroplasty using a pelvic flap is a useful surgical solution for select patients with long upper ureteral obliteration that cannot be managed by a direct reanastomosis. This technique may represent a valid addition to the urologic surgical armamentarium.
输尿管上段（腰部）损伤较为罕见；然而，其重建可能带来相当大的挑战。我们描述了一种针对长段输尿管上段闭塞的新型手术重建技术，对于特定患者而言，这可能是一种可行的治疗选择。
对于一例医源性输尿管上段5厘米损伤的重建，该损伤包括2厘米闭塞段及其两侧各1.5厘米狭窄段，不适合端端再吻合，采用了一种新型的扩大盆腔皮瓣吻合输尿管成形术。切除受损的输尿管段，在输尿管残端内侧做成鱼嘴状，外侧组织缺损用来自肾盂后表面的皮瓣修复。
该手术成功实施，避免了更激进且创伤性大的治疗选择。迄今为止，患者的肾功能稳定，无临床或影像学证据表明存在梗阻。
所描述的使用盆腔皮瓣的扩大吻合输尿管成形术，对于特定的长段输尿管上段闭塞且无法通过直接再吻合处理的患者而言，是一种有效的手术解决方案。该技术可能是泌尿外科手术器械库中的一项有效补充。
