Kim Aram, Nam Wook, Song Sang Hoon, Jeong In Gab, Hong Bumsik
Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Urology. 2018 Jan;111:203-207. doi: 10.1016/j.urology.2017.08.008. Epub 2017 Aug 14.
To investigate the functional outcomes of ileal ureter replacement for complex ureteral loss, including bilateral and single ureter stricture, as a result of various etiologies.
In 2013-2016, 31 patients underwent ileal ureter replacement surgery. The data for their assessments included etiology, combined surgical procedures, ureteral replacement type, postoperative complications, and changes in renal function.
The 31 study patients had a median age of 56.0 (range 18-65) years and were followed for a median of 23.6 (range 6.5-43.2) months. There were 14 bilateral, 12 unilateral, and 5 single-kidney cases. The main indication for surgery was ureteral defects after gynecological surgery and radiation in 24 patients (77.4%). The mean operation time was 370.6 minutes and the median hospital stay was 25.2 (range 6-79) days. Various types of ileal arrangement were performed to cover bilateral ureter loss. After 30 days past surgery, 24 patients (77.4%) were in a stable state and 5 (16.1%) had decreased serum levels of creatinine. Short-term complications greater than grade 3 on the Clavien scale occurred in 10 patients (33.3%), and long-term complications occurred in 27 (87.1%). However, all cases were well relieved by conservative care, and surgical intervention was needed in only 1 case. Apart from 2 patients who died because of the progression of cervical cancer, all patients had stent-free status at 22.4 months.
Ileal ureter replacement is a useful reconstructive surgery for complex ureteral loss, such as bilateral and single-kidney cases resulting from various etiologies.
探讨因各种病因导致的复杂输尿管缺失（包括双侧和单侧输尿管狭窄）行回肠代输尿管术的功能结局。
2013年至2016年，31例患者接受了回肠代输尿管手术。其评估数据包括病因、联合手术操作、输尿管替代类型、术后并发症及肾功能变化。
31例研究患者的中位年龄为56.0岁（范围18 - 65岁），中位随访时间为23.6个月（范围6.5 - 43.2个月）。其中双侧病变14例，单侧病变12例，单肾病例5例。手术的主要指征是24例（77.4%）患者因妇科手术和放疗后出现输尿管缺损。平均手术时间为370.6分钟，中位住院时间为25.2天（范围6 - 79天）。采用了各种类型的回肠排列方式以覆盖双侧输尿管缺失。术后30天，24例（77.4%）患者病情稳定，5例（16.1%）患者血清肌酐水平下降。Clavien分级大于3级的短期并发症发生在10例患者（33.3%），长期并发症发生在27例（87.1%）。然而，所有病例经保守治疗均得到良好缓解，仅1例需要手术干预。除2例因宫颈癌进展死亡的患者外，所有患者在22.4个月时均无支架留置。
回肠代输尿管术是一种用于复杂输尿管缺失（如因各种病因导致的双侧和单肾病例）的有效重建手术。
