Martin X, Ndoye A, Konan P G, Feitosa Tajra L C, Gelet A, Dawahra M, Dubernard J M
Service d'Urologie et de Chirurgie de la Transplantation, Hôpital Edouard Herriot, Lyon, France.
Prog Urol. 1998 Jun;8(3):358-62.
Ureteroscopy is frequently indicated in the treatment of stones of the pelvic ureter. Access to the lumbar ureter is associated with a higher complication rate: wounds, ureteric rupture, haemorrhage, or more serious lesions such as avulsions of the ureter. We present 4 cases of avulsion of the ureter seen in our department, corresponding to 4 men with stones of the lumbar ureter treated by ureteroscopy, 2 of them after failure of in situ extracorporeal lithotripsy (ESWL) and an attempt to "flush" the stone and the other two because ESWL was not available. The ureteric lesion was related to a Dormia catheter in 2 cases and the ureteroscope in 2 cases. The lesion was diagnosed and treated immediately in 2 patients and after a delay in the other 2 cases. Repair consisted of ureteric reimplantation on a Boari flap (1 case), implantation onto a psoas bladder (1 case), ureteroileoplasty (1 case) and autologous transplantation (1 case). Ureteric lesions prevented uretero-ureterostomy. Ureteric reimplantation on psoas bladder and/or Boari flap appears to be the simplest method, but it cannot always be performed. In the case of avulsion of the ureteropelvic junction with a large defect, autologous transplantation is a method of choice in young subjects. Ureteroileoplasty appears to be reserved for elderly patients.
输尿管镜检查常用于治疗盆腔段输尿管结石。进入腰段输尿管会导致更高的并发症发生率，如伤口、输尿管破裂、出血或更严重的损伤，如输尿管撕脱。我们报告了在我院见到的4例输尿管撕脱病例，均为因腰段输尿管结石接受输尿管镜检查的男性患者，其中2例是在原位体外冲击波碎石术（ESWL）失败并尝试“冲洗”结石后发生的，另外2例是因为无法进行ESWL。输尿管损伤在2例中与多尔米亚导管有关，在另外2例中与输尿管镜有关。2例患者损伤被立即诊断并治疗，另外2例有延迟。修复方法包括在博阿里皮瓣上进行输尿管再植（1例）、植入腰大肌膀胱（1例）、输尿管回肠成形术（1例）和自体移植（1例）。输尿管损伤妨碍了输尿管-输尿管吻合术。在腰大肌膀胱和/或博阿里皮瓣上进行输尿管再植似乎是最简单的方法，但并非总是可行。在输尿管肾盂交界处撕脱且有大缺损的情况下，自体移植是年轻患者的一种选择方法。输尿管回肠成形术似乎适用于老年患者。
