Monn M Francesca, Roth Joshua D, Bihrle Richard, Mellon Matthew J
Department of Urology, Indiana University School of Medicine, 1801 Senate St. Suite 220, Indianapolis, IN, 46202, USA.
Int Urol Nephrol. 2018 Aug;50(8):1375-1380. doi: 10.1007/s11255-018-1904-z. Epub 2018 Jun 15.
Radiation-induced ureteral stricture disease poses significant surgical challenges. Ureteral substitution with ileum has long been a versatile option for reconstruction. We evaluated outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction due to radiation-induced ureteral stricture versus other causes.
Between July 1989 and June 2013, 155 patients underwent consecutive ileal ureter creation. The study cohort included 104 patients with complete data sets and at least 7 months of follow up. Records were retrospectively reviewed with regard to demographics, indications, complications, and renal deterioration.
Surgical indications included radiation-induced stricture in 23 (22%) and non-radiation-induced stricture in 81 (78%). Comparing ileal ureter substitution due to radiation versus other stricture etiologies, no statistical significance was observed in regard to age (45.6 vs. 51.2, p = 0.141), hospital length of stay in days (8.8 vs. 7.7, p = 0.216), percent GFR loss (MDRD-4 vs. -5%, p = 0.670 and CKD-EPI-7 vs. -6%, p = 0.914), 30-day surgical complications (26.1 vs. 30.1%, p = 0.658), metabolic acidosis (8.7 vs. 1.2%, p = 0.059), and renal failure requiring dialysis (4.3 vs. 1.2%, p = 0.337). Fistula formation (13.0 vs. 3.7%, p = 0.095), partial small bowel obstructions (21.7 vs. 7.4%, p = 0.063), and small bowel obstructions requiring reoperation (13.0 vs. 1.2%, p = 0.033) approached or reached statistical significance. Using Kaplan-Meier methodology, there was no difference in time to worsening renal outcome between the radiation and non-radiation groups (p > 0.05).
Ureteral substitution with ileum is an effective reconstructive option for radiation-induced ureteral strictures in carefully selected patients.
放射性输尿管狭窄疾病带来了重大的手术挑战。长期以来，回肠代输尿管一直是一种通用的重建选择。我们评估了因放射性输尿管狭窄与其他原因接受回肠代输尿管重建术的患者的治疗效果。
1989年7月至2013年6月期间，155例患者连续接受了回肠代输尿管手术。研究队列包括104例具有完整数据集且至少随访7个月的患者。回顾性审查了有关人口统计学、适应症、并发症和肾功能恶化的记录。
手术适应症包括23例（22%）放射性狭窄和81例（78%）非放射性狭窄。比较因放射与其他狭窄病因导致的回肠代输尿管术，在年龄（45.6对51.2，p = 0.141）、住院天数（8.8对7.7，p = 0.216）、肾小球滤过率损失百分比（MDRD-4对-5%，p = 0.670；CKD-EPI-7对-6%，p = 0.914）、30天手术并发症（26.1对30.1%，p = 0.658）、代谢性酸中毒（8.7对1.2%，p = 0.059）以及需要透析的肾衰竭（4.3对1.2%，p = 0.337）方面未观察到统计学差异。瘘管形成（13.0对3.7%，p = 0.095）、部分小肠梗阻（21.7对7.4%，p = 0.063）以及需要再次手术的小肠梗阻（13.0对1.2%，p = 0.033）接近或达到统计学意义。使用Kaplan-Meier方法，放射组和非放射组肾功能恶化时间无差异（p>0.05）。
对于精心挑选的患者，回肠代输尿管是治疗放射性输尿管狭窄的一种有效重建选择。
