Liu Chunlai, Zhang Xiling, Xue Dongwei, Liu Yili, Wang Ping
Department of Urology, The Fourth Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, China.
Int Urol Nephrol. 2014 Feb;46(2):335-40. doi: 10.1007/s11255-013-0535-7. Epub 2013 Aug 8.
To present experience and feasibility of endoscopic realignment for treatment of delayed recognized iatrogenic complete transected ureteral injuries.
Patients suffering from iatrogenic complete transected ureteral injuries were treated by two surgeons. Five women and 3 men with a mean age of 50.8 years (range 22-69) received diagnosis during the immediate postoperative period (2-6 days after surgery). Ureteral continuity was re-established using a technique combining antegrade flexible ureteroscopy and retrograde rigid ureteroscopy. Then, three ipsilateral 5F double J stents were inserted to assure ureteral patency.
All eight realignment procedures were successful, and no major complications occurred. Average injury length was 1.9 cm (range 1.5-3.0). Average hospitalization time was 8 days (range 3-14). Nephrostomy tubes and stents were removed after a mean period of 3.9 weeks (range 2-6) and 6.8 months (range 5.9-7.1), respectively. At a mean follow-up of 21.5 months (range 10-56), 6 patients were stent-free without image evidence of obstruction, a patient developed strictures was treated with balloon dilation and another exchanged double J stents periodically. No patient has developed significant renal impairment.
Endoscopic realignment is a safe and efficient method as an initial procedure to manage iatrogenic complete transected ureteral injuries in properly selected cases.
介绍内镜复位术治疗延迟诊断的医源性完全性输尿管横断伤的经验及可行性。
两名外科医生对医源性完全性输尿管横断伤患者进行治疗。5名女性和3名男性，平均年龄50.8岁（范围22 - 69岁），于术后即刻（术后2 - 6天）确诊。采用顺行软性输尿管镜与逆行硬性输尿管镜联合技术重建输尿管连续性。然后，插入三根同侧5F双J支架以确保输尿管通畅。
所有八例复位手术均成功，未发生重大并发症。平均损伤长度为1.9厘米（范围1.5 - 3.0厘米）。平均住院时间为8天（范围3 - 14天）。肾造瘘管和支架分别在平均3.9周（范围2 - 6周）和6.8个月（范围5.9 - 7.1个月）后拔除。平均随访21.5个月（范围10 - 56个月），6例患者无支架且影像学无梗阻证据，1例发生狭窄的患者接受了球囊扩张治疗，另1例定期更换双J支架。无患者出现严重肾功能损害。
对于适当选择的病例，内镜复位术作为治疗医源性完全性输尿管横断伤的初始方法是一种安全有效的方法。
