Department of Urology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia.
Department of Urology, Multidisciplinary City Hospital No. 2, St. Petersburg, Russia.
Int J Urol. 2020 Aug;27(8):663-669. doi: 10.1111/iju.14268. Epub 2020 May 31.
To study the long-term results of ureteral reconstruction with the appendix in patients with long ureteral strictures.
From 1998 to 2019, 26 patients were operated with substitution of extended defects of the ureter with the appendix. There were 22 women and four men (mean age 44.7 ± 11.3 years). One patient had stricture of the lumbar ureter because of a gunshot wound. He underwent substitution of the upper third of the right ureter with the appendix. In the other cases, we carried out substitution of the pelvis part of the ureter with appendix, in four cases from the left side. In the last 22 cases, a novel surgical technique for better appendicovesical anastomosis was carried out: a flap was dissected from the dome of the cecum to increase the diameter of anastomosis.
The postoperative follow-up period was from 1 to 21 years. A stricture of uretero-appendical anastomosis developed in four patients (15.4%). Resection of stricture and re-anastomosis was carried out in one case. In another two cases associated with similar complications, endoureterotomy and ureteral stenting were carried out. One patient was managed with percutaneous nephrostomy. Kidney function was restored in all patients. Good short-term results were achieved in 22 patients (84.6%) and long-term (from 1 to 21 years) results in 25 patients (96.2%).
In patients with long ureteral stricture, the use of the appendix can help to restore the function of the upper urinary tract.
研究应用阑尾进行输尿管重建治疗长段输尿管狭窄的长期疗效。
1998 年至 2019 年，我们对 26 例输尿管延长缺损患者采用阑尾替代进行手术治疗。其中女性 22 例，男性 4 例（平均年龄 44.7±11.3 岁）。1 例因枪伤导致腰段输尿管狭窄，行右输尿管上段阑尾替代术。其余患者均行输尿管下段（骨盆段）阑尾替代术，其中左侧 4 例。在最后 22 例患者中，我们采用一种新的手术技术来进行更好的阑尾膀胱吻合术：从盲肠穹窿处游离一个皮瓣以增加吻合口的直径。
术后随访 1 至 21 年。4 例（15.4%）患者发生输尿管-阑尾吻合口狭窄。1 例患者行狭窄段切除及再吻合术，另外 2 例患者因类似并发症行腔内切开及输尿管支架置入术，1 例患者行经皮肾造瘘术。所有患者肾功能均恢复。22 例患者（84.6%）获得了良好的短期疗效，25 例患者（96.2%）获得了长期（1 至 21 年）疗效。
在长段输尿管狭窄患者中，应用阑尾可以帮助恢复上尿路功能。
