Department of Urology, University of Bern, Bern, Switzerland.
J Urol. 2013 Aug;190(2):585-90. doi: 10.1016/j.juro.2013.02.039. Epub 2013 Feb 20.
We compared the long-term results of minimally invasive endourological intervention and open surgical revision in patients with a nonmalignant ureteroileal stricture.
We retrospectively evaluated the records of 74 patients (85 renal units) treated for unilateral or bilateral nonmalignant ureteroileal strictures. Overall, 96 endourological and 35 open surgical procedures were performed. Balloon dilatation and Acucise® or Ho:YAG laser endoureterotomy were used as minimally invasive endourological interventions. Open surgical revision with stricture resection and open ureteroileal end-to-side-reanastomosis was the alternate therapy. Treatment success was defined as radiological normalization or improvement of upper urinary tract morphology combined with absent flank pain, infection, ureteral stents or percutaneous nephrostomies.
Median followup was 29 months (range 2 to 177). The overall success rate was 26% (25 of 96 cases) for endourological intervention vs 91% (32 of 35) for open surgical revision (p <0.001). Subgroup analysis showed a significant difference in the success rate of minimally invasive endourological interventions vs open surgical revision for strictures greater than 1 cm (3 of 52 cases or 6% vs 19 of 22 or 86%, p <0.001). The success rate of endourological and open surgical procedures for strictures 1 cm or less was 50% (22 of 44 cases) and 100% (13 of 13), respectively. After adjusting for multiple preoperative stricture characteristics, only stricture length was strongly and inversely associated with a successful outcome (p <0.001).
Open surgical revision produces better results than minimally invasive endourological intervention for ureteroileal strictures, particularly those greater than 1 cm. The success rate of endourological intervention is acceptable only for ureteroileal strictures 1 cm or less. Therefore, ureteroileal strictures greater than 1 cm should be primarily managed by open surgical revision.
我们比较了微创内镜介入和开放手术修复非恶性输尿管-回肠吻合口狭窄的长期效果。
我们回顾性评估了 74 例（85 个肾脏单位）单侧或双侧非恶性输尿管-回肠吻合口狭窄患者的记录。总共进行了 96 例内镜下和 35 例开放手术。球囊扩张和 Acucise®或 Ho:YAG 激光输尿管内切开术作为微创内镜介入治疗。开放手术修复采用狭窄切除和开放输尿管-回肠端侧吻合术作为替代治疗。治疗成功定义为影像学上的上尿路形态正常或改善，同时无腰痛、感染、输尿管支架或经皮肾造口术。
中位随访时间为 29 个月（范围 2 至 177 个月）。内镜治疗的总体成功率为 26%（96 例中的 25 例），而开放手术修复的成功率为 91%（35 例中的 32 例）（p<0.001）。亚组分析显示，对于大于 1cm 的狭窄，微创内镜介入与开放手术修复的成功率有显著差异（52 例中的 3 例或 6%，22 例中的 19 例或 86%，p<0.001）。对于 1cm 或以下的狭窄，内镜和开放手术的成功率分别为 50%（44 例中的 22 例）和 100%（13 例中的 13 例）。在调整了多个术前狭窄特征后，只有狭窄长度与成功结果呈强烈的负相关（p<0.001）。
对于输尿管-回肠吻合口狭窄，开放手术修复的效果优于微创内镜介入治疗，尤其是对于大于 1cm 的狭窄。内镜治疗的成功率仅适用于 1cm 或以下的输尿管-回肠狭窄。因此，大于 1cm 的输尿管-回肠狭窄应主要通过开放手术修复。
