Bhaskarapprakash A R, Karri Leelakrishna, Velmurugan P, Venkatramanan S, Natarajan K
Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Surg Res Pract. 2020 Oct 19;2020:3198689. doi: 10.1155/2020/3198689. eCollection 2020.
The aim of the study is to present our experience with the management of ureteral avulsions following semirigid ureteroscopy for ureteral stones. This is one of the largest series reported so far.
It is a retrospective and observational study done at Sri Ramachandra Institute of Higher Education and Research over the last 18 years.
There were seven cases of ureteral avulsion following semirigid ureteroscopy. All patients were males with a mean age of 35.7 years. All had impacted stones, with proximal ureteric location in 6 patients and distal ureteric location in 1 patient. Five cases had two-point avulsions with loss of entire ureter. Two cases had one-point avulsion: one distal ureteric and the other mid-ureteric. Of the five cases with whole length ureteral avulsion, four were managed by classical ileal replacement of ureter and the the fifth case was managed by ileal replacement of ureter by the Yang-Monti technique. Of the two cases with one-point avulsion, one was managed by uretero-neocystostomy and the other by uretero-ureterostomy. All the patients had successful outcome.
Even though rare, ureteral avulsion can potentially happen especially when dealing with impacted ureteric stones. Being conscious of the possible occurrence of this serious complication during any difficult ureteroscopy and exercising utmost care during the procedure are important preventive measures. However, this catastrophe can be successfully managed by either immediate definitive repair or in a staged manner.
本研究旨在介绍我们在处理输尿管结石行半硬性输尿管镜检查术后输尿管撕脱伤方面的经验。这是迄今为止报道的最大病例系列之一。
这是一项在过去18年于斯里兰卡拉马钱德拉高等教育与研究机构开展的回顾性观察研究。
半硬性输尿管镜检查术后出现7例输尿管撕脱伤。所有患者均为男性，平均年龄35.7岁。所有患者均有结石嵌顿，6例结石位于输尿管上段，1例位于输尿管下段。5例为两点撕脱，输尿管完全缺失。2例为单点撕脱：1例位于输尿管下段，另1例位于输尿管中段。在5例输尿管全长撕脱的病例中，4例采用经典回肠代输尿管术治疗，第5例采用杨-蒙蒂（Yang-Monti）技术行回肠代输尿管术。在2例单点撕脱的病例中，1例采用输尿管膀胱新造口术治疗，另1例采用输尿管输尿管吻合术治疗。所有患者均取得成功结果。
尽管输尿管撕脱伤较为罕见，但尤其在处理嵌顿性输尿管结石时有可能发生。在任何困难的输尿管镜检查过程中意识到这种严重并发症的可能发生，并在操作过程中格外小心，是重要的预防措施。然而，这种严重情况可通过立即进行确定性修复或以分期方式成功处理。
