Li Xinfei, Zhu Weijie, Zeng Zhen, Wang Qian, Fang Dong, Li Zhihua, Guan Hua, Huang Yanbo, Zhang Peng, Zhu Hongjian, Li Xuesong, Zhou Liqun
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Transl Androl Urol. 2021 Aug;10(8):3226-3238. doi: 10.21037/tau-21-255.
The selection of treatment for bilateral ureteral strictures caused by radiotherapy in patients with gynecological tumors often brings great challenges to urologists. This study was designed to analyze the characteristics of radiation-induced ureteral strictures and summarize the surgical experience of bilateral ileal ureter substitution.
We retrospectively collected the medical records of 18 patients between June 2010 and June 2019 who had a radiation-induced bilateral ureteral strictures. Time interval from radiotherapy to the discovery of ureteral stricture was categorized into short-term (less than 12 months) and long-term (over 12 months) groups. All patients received reverse "7" bilateral ileal ureteral substitution. Surgical success was defined as no restenosis, relief of symptoms, and improved/stabilized hydronephrosis.
The patients had been suffered from ureteral stricture for a median of 12 [2-106] months. The mean length of the left and right ureteral stricture was 9.6±2.6 and 8.8±3.2 cm, respectively. The mean length of the ileal graft was 29.1±7.4 cm. The mean operative time was 308.4±70.2 min, and the mean estimated blood loss was 254.7±166.2 mL. The postoperative hospital stays in the short-term group was significantly shorter than that in the long-term group (14.0 20.6 days, P=0.049). During a median follow-up time of 24.1 (4.5-71.9) months, the success rate was 94.4%. Eight minor complications and two major complications occurred in 7 patients.
Bilateral ileal ureter substitution can be an effective strategy for radiation-induced ureteral stricture in patients with gynecological tumors.
妇科肿瘤患者放疗所致双侧输尿管狭窄的治疗选择常常给泌尿外科医生带来巨大挑战。本研究旨在分析放射性输尿管狭窄的特点并总结双侧回肠代输尿管术的手术经验。
我们回顾性收集了2010年6月至2019年6月期间18例放射性双侧输尿管狭窄患者的病历。从放疗至发现输尿管狭窄的时间间隔分为短期（少于12个月）和长期（超过12个月）组。所有患者均接受反向“7”形双侧回肠代输尿管术。手术成功定义为无再狭窄、症状缓解以及肾积水改善/稳定。
患者输尿管狭窄的中位时间为12 [2 - 106]个月。左侧和右侧输尿管狭窄的平均长度分别为9.6±2.6 cm和8.8±3.2 cm。回肠移植物的平均长度为29.1±7.4 cm。平均手术时间为308.4±70.2分钟，平均估计失血量为254.7±166.2 mL。短期组的术后住院时间明显短于长期组（14.0对20.6天，P = 0.049）。在中位随访时间24.1（4.5 - 71.9）个月期间，成功率为94.4%。7例患者发生了8例轻度并发症和2例严重并发症。
双侧回肠代输尿管术对于妇科肿瘤患者放射性输尿管狭窄可能是一种有效的治疗策略。
