膀胱肌瓣修复输尿管长段缺损的疗效观察

The effect of bladder muscle flap replacement for long segment defect of ureter

目的观察膀胱肌瓣修复输尿管中下段长段缺损的远期疗效,探讨输尿管长段缺损的重建方法。方法收集2001年1月至2006年9月我院采用膀胱肌瓣卷管输尿管替代治疗21例输尿管中下段狭窄或缺损病例,观察其术后利尿肾图、B超、膀胱造影检查结果。结果术后8周拔除输尿管支架管,20例病例1次手术成功,1例病例术后出现尿瘘,于半年后再次行膀胱肌瓣输尿管替代术。术后随访输尿管无狭窄,排尿良好。超声、膀胱排尿期造影显示所有患者患侧上尿路积水明显减轻,2例出现膀胱输尿管轻度返流,利尿肾图显示患侧肾脏功能恢复良好,上尿路无梗阻。结论膀胱肌瓣卷管输尿管替代是处理输尿管中下段长段狭窄的有效方法,远期疗效可靠,并发症少。

Objective To observe the effect of bladder muscle flaps for the treatment of long segment defect of ureter and to investigate a suitable reconstruction method. Methods From Jan 2001 to Sep 2006, a total of 21 cases with middle and/or inferior segment ureter de- feet were replaced by bladder muscle flaps. All these eases were followed up for 18.3 months （12 ~ 24 months）, diuresis renogram, ultra- sound and cystography was observed after operation. Results The operations were successful in 20 of the 21 cases, and the double-J tubes were removed at 8 weeks after operation. One case with ureter fistulas after operation and operated again half an year later. No ureterosteno- ma happened. All patients, the dropsy of upper urinary tract was alleviated obviously, two patients were observed slightly backstreaming by transonogram and urethracy opacification. The function of sick kidney recovered according to diuresis renogram. Conclusion Bladder muscle flap replacement is an effective method for long ureter defect in middle and/or inferior segment by bladder muscle flaps.