Department of Urology, Peking University First Hospital, Beijing, China.
Institute of Urology, Peking University, Beijing, China.
Int J Urol. 2020 May;27(5):377-386. doi: 10.1111/iju.14222. Epub 2020 Mar 18.
Long ureteral defects have remained a challenge to urologists for a long time. Bowel interposition, including ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance, even though it is a complicated procedure and associated with some potential complications. Mucus obstruction and metabolic disorders are common complications of intestinal substitution. To circumvent these troubles, modified techniques, such as tapering the bowel graft, intestinal onlay flap and the Yang-Monti procedure, are used. In particular, Yang-Monti ileal ureter replacement is a highly effective option for ureteral reconstruction, and the incidence of complications would be significantly reduced in select patients. After being combined with the Boari flap or psoas hitch technique, the length of intestinal segment used can also be significantly reduced. Most recent long-term results suggest that ileal ureter replacement with antireflux anastomosis seems to be remarkably free of complications, and we highly praise the distal nipple valve technique. Appendiceal interposition is available for patients with normal appendix, and usually this procedure is limited to reconstructing the right ureter. Appendiceal onlay ureteroplasty has emerged as a feasible and effective option to manage patients with complex proximal and mid-ureteral strictures of the right side. The colon is rarely used for ureteral reconstruction because of its large caliber and mucous surface area. However, a reconfigured colon segment is a good substitute to reconstruct long-segment ureteral defects, and long-term follow up confirmed minimal complications and improved renal function. This review provides a comprehensive perspective on complex ureteral reconstruction and replacement using intestinal segments, in particular, ileal ureter replacement.
长期的输尿管缺损一直是泌尿科医生面临的挑战。肠段替代术，包括回肠代输尿管、阑尾代输尿管和重构结肠替代术，已经得到了广泛的认可，尽管它是一种复杂的手术，并伴有一些潜在的并发症。肠替代术后的黏液阻塞和代谢紊乱是常见的并发症。为了避免这些问题，改良技术，如肠段逐渐变细、肠段黏膜瓣和 Yang-Monti 术式，被应用于临床。特别是，Yang-Monti 回肠代输尿管术是一种有效的输尿管重建方法，在选择合适的患者中，并发症的发生率会显著降低。当与 Boari 皮瓣或腰大肌悬吊技术相结合时，也可以显著减少使用的肠段长度。最近的长期结果表明，带抗反流吻合的回肠代输尿管似乎并发症显著减少，我们高度评价远端乳头瓣技术。对于有正常阑尾的患者，可以选择阑尾代输尿管术，通常该手术仅限于重建右侧输尿管。阑尾黏膜瓣输尿管成形术已成为一种可行且有效的方法，可用于治疗右侧复杂的近段和中段输尿管狭窄患者。由于其管径大和黏膜表面积大，结肠很少用于输尿管重建。然而，重构的结肠段是重建长段输尿管缺损的良好替代品，长期随访证实并发症少，肾功能改善。本综述提供了一个使用肠段进行复杂输尿管重建和替代的全面视角，特别是回肠代输尿管术。
