Fan Shubo, Yin Lu, Yang Kunlin, Wang Jie, Li Xinfei, Xiong Shengwei, Yu Xiaoteng, Li Zhihua, Guan Hua, Zhu Hongjian, Zhang Peng, Li Xuesong, Zhou Liqun
Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China.
Department of Urology, Beijing Jiangong Hospital, Beijing, China.
J Endourol. 2021 Feb;35(2):192-199. doi: 10.1089/end.2020.0686.
To share the technique of posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures as well as our initial experience with the technique. From October 2018 to September 2019, 10 cases of robotic and laparoscopic posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures were recruited from our database of Reconstruction of Urinary Tract: Technology, Epidemiology and Result (RECUTTER). The perioperative and follow-up data were recorded. Complete success was defined as the absence of clinical symptoms, relieved stenosis on imaging, and a stable estimated glomerular filtration rate without serious complications. All surgeries were completed without serious complications. There were eight laparoscopic surgeries and two robotic surgeries. The median length of defect after posteriorly augmented anastomosis was 3 cm (range, 3-5 cm). The median length of the lingual mucosa graft was 4 cm (range, 3-5 cm). The median operative time was 237 minutes (range, 189-310 minutes). The median estimated blood loss was 40 mL (range, 10-100 mL). The median postoperative length of stay was 7.5 days (range, 5-22 days). The Double-J stent was removed median 3.5 months (range, 2-7 months) after the surgery. At the median follow-up of 11 months (range, 7-20 months), all patients achieved the successful criteria of treatment. The posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures is a feasible and safe technique, which may be an option especially for strictures marginally longer than those that can be safely repaired via end-to-end anastomosis.
分享采用舌黏膜覆盖移植片进行后向增强吻合性输尿管成形术治疗近端输尿管长段狭窄的技术以及我们对该技术的初步经验。2018年10月至2019年9月，从我们的尿路重建数据库（RECUTTER：技术、流行病学与结果）中选取10例采用机器人和腹腔镜下舌黏膜覆盖移植片后向增强吻合性输尿管成形术治疗近端输尿管长段狭窄的病例。记录围手术期和随访数据。完全成功定义为无临床症状、影像学检查显示狭窄缓解、估计肾小球滤过率稳定且无严重并发症。所有手术均顺利完成，无严重并发症。其中有8例腹腔镜手术和2例机器人手术。后向增强吻合术后缺损的中位长度为3 cm（范围3 - 5 cm）。舌黏膜移植片的中位长度为4 cm（范围3 - 5 cm）。中位手术时间为237分钟（范围189 - 310分钟）。中位估计失血量为40 mL（范围10 - 100 mL）。术后中位住院时间为7.5天（范围5 - 22天）。术后中位3.5个月（范围2 - 7个月）取出双J支架。在中位随访11个月（范围7 - 20个月）时，所有患者均达到治疗成功标准。采用舌黏膜覆盖移植片进行后向增强吻合性输尿管成形术治疗近端输尿管长段狭窄是一种可行且安全的技术，对于那些略长于可通过端端吻合安全修复的狭窄，该技术可能是一种选择。
