Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
Prog Urol. 2021 May;31(6):357-367. doi: 10.1016/j.purol.2020.10.002. Epub 2020 Nov 12.
Ileal ureter is a technique that consists of replacing the ureter by a segment of ileum to treat a long ureteric lesion or a lesion involving the lumbar ureter. The primary objective of our study was to assess the early perioperative morbidity of ileal ureter according to the Clavien-Dindo classification. The secondary objectives were to assess the morbidity and the medium- and long-term outcome of renal function.
Single-centre retrospective study, collecting data from patients operated between February 2005 and October 2019. All patients who underwent ileal ureter replacement surgery in our unit were included in this analysis. The ureteric defect was longer than five centimetres and involved the pelvic and/or iliac and/or lumbar ureter. All ileal ureter replacements were performed by open surgery using isoperistaltic ileal grafts.
Twenty-one patients (11 women and 10 men) underwent total or subtotal, unilateral or bilateral ileal ureter replacement, corresponding to 25 kidneys. The grade III early postoperative complication rate was 9.5% (two cases) mainly consisting of bleeding. No grade IV or V complications were observed. With a mean follow-up of 85 months, long-term morbidity essentially consisted of infectious complications. No patients developed anastomotic strictures. Mean serum creatinine was 116.3μmol/L preoperatively, 105.6μmol/L one month postoperatively and 112.2μmol/L at last follow-up. Renal function was generally preserved or even improved, except for patients with preoperative renal failure.
Ileal ureter replacement is a surgical alternative associated with low morbidity and satisfactory long-term functional results.
回肠代输尿管术是一种用一段回肠替代输尿管来治疗长段输尿管病变或累及腰段输尿管的病变的技术。我们研究的主要目的是根据 Clavien-Dindo 分类评估回肠代输尿管的早期围手术期发病率。次要目标是评估发病率以及肾功能的中、长期结果。
这是一项单中心回顾性研究，收集了 2005 年 2 月至 2019 年 10 月期间在我院接受手术的患者数据。所有在我院接受回肠代输尿管置换术的患者均纳入本分析。输尿管缺损大于 5 厘米，累及盆腔和/或髂骨和/或腰段输尿管。所有回肠代输尿管置换术均采用开放手术，使用等蠕动性回肠移植物进行。
21 例患者（11 名女性和 10 名男性）接受了单侧或双侧的全或次全回肠代输尿管置换术，涉及 25 个肾脏。术后第 3 级早期并发症发生率为 9.5%（2 例），主要为出血。未观察到 4 级或 5 级并发症。平均随访 85 个月后，长期并发症主要为感染性并发症。无吻合口狭窄患者。术前血清肌酐平均值为 116.3μmol/L，术后 1 个月为 105.6μmol/L，末次随访时为 112.2μmol/L。肾功能一般得到保留，甚至有所改善，除了术前有肾衰竭的患者。
回肠代输尿管置换术是一种并发症发生率低且长期功能结果满意的手术选择。
3 级
