软式内镜辅助逆行性输尿管导管置入术对Bricker回肠膀胱术后输尿管回肠吻合口狭窄的即刻再通疗效研究

Study on the efficacy of retrograde ureteral catheterization assisted by flexible endoscope in the treatment of uretero-ileal anastomotic stenosis after Bricker ileal bladder operation

摘要:

目的 探讨软式内镜辅助逆行性输尿管导管置入术，对Bricker回肠膀胱术后，输尿管回肠吻合口狭窄即刻再通的疗效。方法 回顾性分析2016年11月－2022年10月该院收治的17例Bricker回肠膀胱术患者的临床资料，共28处输尿管回肠吻合口狭窄，均行软式内镜辅助逆行性输尿管导管置入术治疗。结果 所有患者的总手术时间均 < 50 min。经内镜治疗成功再通的有21处。中位住院时间为6（4.75，8.50）d。28处输尿管回肠吻合口狭窄中，21处内镜下即刻再通成功（左侧10处，右侧11处），7处内镜下即刻再通失败（左侧4处，右侧3处）。21处内镜下即刻再通成功包括：单纯性逆行性置入输尿管导管15处，内镜下输尿管回肠吻合口扩张、网篮取石和逆行性支架置入1处，超细内镜下逆行性输尿管支架置入术3处，十二指肠镜下逆行性输尿管支架置入术2处。17例患者，输尿管支架尿液引流通畅，代膀胱回肠及输尿管回肠吻合口均有不同程度擦伤和少量出血，未发生迟发性出血、穿孔、严重泌尿系感染、支架堵塞和移位等严重并发症。结论 软式内镜辅助逆行性输尿管导管置入术，对输尿管回肠吻合口狭窄的即刻再通，安全且有效。值得应用于临床。

Abstract:

Objective To explore the immediate recanalization efficacy of flexible endoscopy-assisted retrograde ureteral catheterization for uretero-ileal anastomotic stenosis after Bricker ileal bladder surgery.Method A retrospective analysis was conducted on the clinical data of 17 patients who underwent Bricker ileal bladder surgery in the hospital from November 2016 to October 2022. There were a total of 28 sites of ureterileal anastomotic stenosises, all of which were treated with flexible endoscopy-assisted retrograde ureteral catheterization.Result There were 21 sites who successfully underwent recanalization after endoscopic treatment, the median length of hospital stay was 6 (4.75, 8.50) days. Among the 28 uretero-ileal anastomotic stenosises, 21 sites were successfully recanalized immediately under endoscopy (10 on the left and 11 on the right), while 7 sites failed to recanalize immediately under endoscopy (4 on the left and 3 on the right). The 21 sites of successful immediate recanalization under endoscopy include: 15 sites of simple retrograde placement of ureteral catheters, 1 site of endoscopic ureterileal anastomotic dilation, net basket stone removal and retrograde stent placement, 3 sites of retrograde ureteral stent placement under ultra-fine endoscopy, and 2 sites of retrograde ureteral stent placement under duodenoscopy. The total operation time of all patients was less than 50 minutes. Among the 17 patients, the urine drainage of the ureteral stent was unobstructed. There were varying degrees of abrasions and a small amount of bleeding at the bladder ileal and ureterileal anastomoses. No serious complications such as delayed bleeding, perforation, severe urinary tract infection, stent blockage or displacement occurred.Conclusion Flexible endoscopy-assisted retrograde ureteral catheterization are safe and effective for immediate recanalization of uretero-ileal anastomotic stenosis. It is worth applying in clinical practice.