Nakajima Hideaki, Koga Hiroyuki, Kosaka Seitaro, Ikari Mao, Lane Geoffrey J, Yamataka Atsuyuki
Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
Department of Pediatric Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
European J Pediatr Surg Rep. 2023 Apr 10;11(1):e10-e14. doi: 10.1055/a-2035-4637. eCollection 2023 Jan.
An 11-year-old boy was referred for further management of a 6-cm-long grossly stenosed ureter following two failed left ureteropelvic junction (UPJ) obstruction repairs elsewhere. A tapered segment of the descending colon (TDC) was used successfully for ureteral reconstruction. The UPJ was exposed through a left flank incision. The stenosed segment was excised; both ends appeared severely inflamed and thickened. Tissue interposition was required and ureteroplasty with a TDC was performed by incising the peritoneum adjacent to the excised ureter to mobilize the descending colon to the retroperitoneal space. To prepare the TDC, an 8-cm segment of the colon with intact blood vessels was isolated, tapered, and sutured into a funnel shape using a 14-Fr catheter as a temporary stent. After colocolostomy, the colon was returned to the abdominal cavity, the peritoneum was closed carefully to prevent vascular compromise, and the TDC was anastomosed to the ureter and renal calyx with interrupted absorbable sutures. A double J stent (DJS) and percutaneous nephrostomy tube were placed. Postoperative recovery was uneventful. The DJS was removed on day 50 after confirming smooth urine flow through both the ureter-TDC and calyx-TDC anastomoses. Diuretic renography performed 68 days postoperatively was unobstructed. The patient is currently well after 12 months follow-up. This would appear to be the first report of a TDC being used to create a funnel-shaped segment to reconstruct a long, grossly stenosed ureter. The TDC is simpler than the re-tubularizing colon but requires monitoring for postoperative mucus-related complications and malignant transformation.
一名11岁男孩因左侧输尿管肾盂连接部（UPJ）梗阻在其他地方两次修复失败后，转诊来接受对一条6厘米长严重狭窄输尿管的进一步治疗。一段降结肠锥形段（TDC）成功用于输尿管重建。通过左腰部切口暴露UPJ。切除狭窄段；两端看起来严重发炎和增厚。需要进行组织间置，通过切开切除输尿管附近的腹膜将降结肠动员到腹膜后间隙，用TDC进行输尿管成形术。为准备TDC，分离一段8厘米长血管完整的结肠，将其锥形化，并使用14F导管作为临时支架缝合成漏斗状。结肠结肠吻合术后，将结肠放回腹腔，仔细缝合腹膜以防止血管受压，并用间断可吸收缝线将TDC与输尿管和肾盏吻合。放置双J支架（DJS）和经皮肾造瘘管。术后恢复顺利。在确认输尿管-TDC和肾盏-TDC吻合口尿液流动顺畅后，于第50天取出DJS。术后68天进行的利尿肾图检查显示无梗阻。经过12个月的随访，患者目前情况良好。这似乎是关于使用TDC创建漏斗状段来重建长的、严重狭窄输尿管的首例报告。TDC比结肠再管状化更简单，但需要监测术后与黏液相关的并发症和恶性转化。
