Lazica D A, Brandt A S, Roth S
Klinik für Urologie und Kinderurologie, HELIOS Klinikum Wuppertal, Lehrstuhl der Universität Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Deutschland,
Urologe A. 2014 Jul;53(7):968-75. doi: 10.1007/s00120-014-3499-z.
Open surgical reconstruction of the ureter is a urological procedure with a potentially high risk of complications. The correct selection of patients and time of operation are important aspects regarding the treatment strategy. Position and length of the affected ureter segment to be reconstructed determine the surgical intervention possibilities. The psoas hitch procedure is a well-established technique for distal reconstruction of the ureter where most iatrogenic injuries occur. In more proximal or complex defects, several procedures are available. Partial or complete replacement of the ureter with bowel is still considered the standard for bridging long ureteral defects but is accompanied with higher intra- and postoperative complication rates. In specific patients and situations, autotransplantation of the kidney and subcutaneous pyelovesical bypasses are clinical options. Using mucosal grafts or tissue engineering may be new therapeutic prospects to cover ureteral defects but the clinical impact still needs to be clarified. All therapeutic strategies share the fact that great surgical expertise and experience are necessary as the operative technique must be mastered to avoid severe complications.
输尿管开放手术重建是一种泌尿外科手术，具有潜在的高并发症风险。正确选择患者和手术时机是治疗策略的重要方面。待重建的患侧输尿管段的位置和长度决定了手术干预的可能性。腰大肌牵拉术是一种成熟的输尿管远端重建技术，大多数医源性损伤都发生在此处。对于更近端或更复杂的缺损，有多种手术方法可供选择。用肠管部分或完全替代输尿管仍是修复长段输尿管缺损的标准方法，但会伴随着更高的术中及术后并发症发生率。在特定的患者和情况下，自体肾移植和皮下肾盂膀胱旁路术是临床选择。使用黏膜移植物或组织工程可能是覆盖输尿管缺损的新治疗前景，但临床影响仍有待阐明。所有治疗策略都有一个共同事实，即需要高超的手术专业知识和经验，因为必须掌握手术技术以避免严重并发症。
