Mesrobian H G, Kelalis P P
Department of Urology, Mayo Clinic, Rochester, Minnesota.
J Urol. 1989 Nov;142(5):1285-7. doi: 10.1016/s0022-5347(17)39058-4.
Ureterocalicostomy was performed in 21 patients for ureteropelvic junction obstruction. Ten patients had failed pyeloplasty, 10 had anomalies of renal fusion, ascent or rotation in conjunction with ureteropelvic junction obstruction and 1 had failed prior ureterocalicostomy. Patient age at operation ranged from 6 months to 17 years and averaged 9 years. Of the 21 patients in this series 19 had excellent results after ureterocalicostomy with decrease or total elimination of hydronephrosis. There were 2 postoperative complications in 2 patients: prolonged anastomotic urinary leakage in 1 and a Candida perinephric abscess in 1. Ureterocalicostomy should be considered in selected patients with previous unsuccessful pyeloplasty, ureteropelvic junction obstruction associated with anomalies of renal fusion, rotation or ascent, an intrarenal pelvis or a short ureter. Although endopyelotomy or ureteropelvic junction dilation should be considered in patients who fail pyeloplasty, ureterocalicostomy continues to be a reliable salvage procedure in these patients; it bypasses extensive peripelvic scarring, provides for dependent drainage and compensates for lack of adequate ureteral length.
21例患者因肾盂输尿管连接处梗阻接受了输尿管肾盂造口术。10例患者肾盂成形术失败，10例患者在肾盂输尿管连接处梗阻的同时合并肾脏融合、上升或旋转异常，1例患者先前的输尿管肾盂造口术失败。手术时患者年龄从6个月至17岁不等，平均9岁。在该系列的21例患者中，19例在输尿管肾盂造口术后效果良好，肾积水减轻或完全消除。2例患者出现2种术后并发症：1例吻合口尿漏持续时间延长，1例念珠菌性肾周脓肿。对于先前肾盂成形术失败、肾盂输尿管连接处梗阻合并肾脏融合、旋转或上升异常、肾盂内型或输尿管较短的特定患者，应考虑输尿管肾盂造口术。虽然肾盂成形术失败的患者应考虑内镜下肾盂切开术或肾盂输尿管连接处扩张术，但输尿管肾盂造口术仍是这些患者可靠的挽救手术；它可绕过广泛的肾盂周围瘢痕形成，实现重力引流，并弥补输尿管长度不足的问题。
