Liu Pei, Wu Xin, Zhu Yu-ze, Tang Qi, Fang Dong, Li Xue-song, Hao Jin-rui, Zhou Li-qun
Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2015 Aug 18;47(4):643-7.
To investigate the efficacy of ileal ureteric replacement in the treatment of iatrogenic long segment ureteric injuries.
The hospital records of 9 cases with iatrogenic long segment ureteric injuries during Aug. 2010 to Sept. 2014 treated with ileal ureteric replacement were retrospectively reviewed and followed-up postoperatively. The patients included 3 males and 6 females with a median age of 40 years. The length of injury segment was 13-25 cm (median 20 cm). The etiology of the iatrogenic injury was urological surgery (n=6), gynecological surgery (n=2) and general surgery (n=1), respectively. The ureter stent was removed in 1-2 month postoperatively in all the 9 cases.
All the operations were successful. The operation time was 203-394 min, with the average of (278.1±68.8) min. The bleeding volume was 10-1 000 mL, with the median of 200 mL. The mean length of hospital stay was (16.8±7.5) days. Four minor complications (Grade I-II) developed, including 3 ileus (33.3%) and 1 proximal anastomotic leakage (11.1%). The median follow-up time was 11 months, serum creatinine decreased or remained stable in 8 patients (88.9%). Three patients (33.3%) developed mild hydronephrosis and short-time urinary tract infection was seen in 1 patient (11.1%). Metabolic acidosis was not detected during the follow-up.
Ileal ureteric replacement is a safe and effective method in patients with complex or difficult iatrogenic long segment ureteric injuries.
探讨回肠代输尿管术治疗医源性长段输尿管损伤的疗效。
回顾性分析2010年8月至2014年9月采用回肠代输尿管术治疗的9例医源性长段输尿管损伤患者的病历资料，并进行术后随访。患者包括3例男性和6例女性，中位年龄40岁。损伤段长度为13 - 25 cm（中位值20 cm）。医源性损伤的病因分别为泌尿外科手术（n = 6）、妇科手术（n = 2）和普通外科手术（n = 1）。所有9例患者均在术后1 - 2个月拔除输尿管支架。
所有手术均成功。手术时间为203 - 394分钟，平均（278.1±68.8）分钟。出血量为10 - 1000 mL，中位值为200 mL。平均住院时间为（16.8±7.5）天。发生4例轻度并发症（Ⅰ - Ⅱ级），包括3例肠梗阻（33.3%）和1例近端吻合口漏（11.1%）。中位随访时间为11个月，8例患者（88.9%）血清肌酐下降或保持稳定。3例患者（33.3%）出现轻度肾积水，1例患者（11.1%）出现短期泌尿系统感染。随访期间未检测到代谢性酸中毒。
对于复杂或困难的医源性长段输尿管损伤患者，回肠代输尿管术是一种安全有效的方法。
