输尿管镜下输尿管长段撕脱的处理和思考

Treatment and consideration of long segment ureteral avulsion under ureteroscopy

摘要:

目的 探讨输尿管镜手术致输尿管长段撕脱的处理方法。方法 对3例输尿管长段分别为18、20和21 cm撕脱患者进行诊治，1例行膀胱瓣管残端吻合术，1例行膀胱瓣管肾盂吻合术，1例行回肠代输尿管术，均于腔内放置双J管。结果 行膀胱瓣管输尿管残端吻合术的患者于术后7个月取出双J管，1个月后复查无肾积水，无其他并发症，恢复良好。行膀胱瓣管肾盂吻合术的患者，术后3个月取出双J管，1个月后复查，出现吻合口旁边囊肿，后期行自体肾移植术。行回肠代输尿管术的患者，于术后6个月取出双J管，1个月后复查无肾积水，恢复良好。结论 输尿管镜下输尿管长段撕脱需及时行膀胱瓣管代输尿管术、回肠代输尿管术或自体肾移植术，需在术后6个月以后考虑取出双J管，使输尿管损伤得到最佳处理效果。

Abstract:

Objective To investigate the treatment of long ureteral avulsion by ureteroscopy.Methods Through the diagnosis and treatment of 3 patients with ureteral avulsion of 18, 20 and 21 cm respectively, 1 patient underwent vesical valve stump anastomosis, 1 patient underwent vesical valve pelvis anastomosis, 1 patient underwent ileal ureteral replacement, and all the patients were placed with double J tube in the cavity.Results 7 months after the anastomosis of the ureteral stump, the patient took out the double J tube, one month later, there was no hydronephrosis, no other complications, and the patient recovered well. In the patients with bladder valve and renal pelevoid anastomosis, the double J tube was removed 3 months after operation, and reexamination showed cyst near the anastomotic site 1 month later. Autologous renal transplantation was performed later. In patients with ileal ureteral replacement, the double J tube was removed 6 months after operation, and there was no hydronephrosis reexamination 1 month later, and the recovery was good.Conclusion Long ureteral avulsion under ureteroscopy should be performed in time, such as bladder flap ureteral replacement, ileum ureteral replacement, and autogenous kidney transplantation. Only after more than 6 months after operation should the double J tube be taken out, so that the ureteral injury can get the best treatment results.