Loran O B, Guspanov R I, Kotov S V, Seregin A V, Morozov A D, Bogdanov D A
Russian Medical Academy of Continuous Professional Education, Department of Urology and Surgical Andrology, Moscow, Russia.
FGAOU VO Pirogov Russian National Research University, Moscow, Russia.
Urologiia. 2024 May(2):11-17.
Radiation therapy is one of the main methods of treating pelvic malignant tumors, which provides good oncological results. Specific features of the pelvic anatomy may result in various radiation injuries of adjacent organs, which are complicated by genitourinary fistulas, post-radiation fibrosis with the formation of hydronephrosis, microcyst, reducing the quality of life.
To describe the relevance and importance of the correct choice of surgical treatment in patients with post-radiation urinary tract injuries.
The group of irradiation injuries of the urinary tract included 60 patients aged 39-65 years. 19 (31.7%) women with various post-radiation ureteral injurie, who underwent reconstructive surgery using isolated bowel segments, were included in the study group.
Substitution of the ureter by intestinal segment in patients with extensive post-radiation ureteral strictures provides good functional results. During follow-up computed tomography, an absence of urinary tract obstruction was confirmed in 16 (84.2%) patients, while in 3 (15.8%) cases an obstruction was diagnosed, followed by nephrectomy due to loss of function in 1 woman (5.3%). When assessing renal function using the dynamic nuclear scintigraphy, improvement in function was revealed in 14 (73.7%) patients, stabilization in 2 (10.5%), deterioration in 3 (15.8%). Histological examination revealed that inflammatory infiltration and the absence of a clear margins of the stricture area were more pronounced in patients who had had internal ureteral stent prior to reconstruction. A number of clinical cases demonstrating the treatment tactics of this group of patients is presented in the article.
Based on the extensive experience of two centers and long follow-up, we suggest scientifically proven approach to surgical treatment of radiation injuries of the urinary tract, the implementation of which will significantly improve medical and social rehabilitation.
放射治疗是治疗盆腔恶性肿瘤的主要方法之一，能取得良好的肿瘤治疗效果。盆腔解剖结构的特殊特征可能导致相邻器官发生各种放射性损伤，进而并发泌尿生殖瘘、放射性纤维化并形成肾积水、微囊肿，降低生活质量。
描述放射性尿路损伤患者正确选择手术治疗的相关性和重要性。
尿路照射损伤组包括60例年龄在39至65岁之间的患者。研究组纳入了19例（31.7%）患有各种放射性输尿管损伤的女性，她们接受了使用孤立肠段的重建手术。
对于放射性输尿管广泛狭窄的患者，用肠段替代输尿管可取得良好的功能效果。在随访计算机断层扫描中，16例（84.2%）患者被证实无尿路梗阻，而在3例（15.8%）病例中诊断出梗阻，随后1名女性（5.3%）因功能丧失而接受了肾切除术。在使用动态核素肾图评估肾功能时，14例（73.7%）患者功能改善，2例（10.5%）稳定，3例（15.8%）恶化。组织学检查显示，重建前放置输尿管内支架的患者炎症浸润更明显，狭窄区域边界不清晰。本文介绍了一些展示该组患者治疗策略的临床病例。
基于两个中心的丰富经验和长期随访，我们建议采用经科学验证的方法治疗尿路放射性损伤，实施该方法将显著改善医疗和社会康复效果。
