抗反流技术的回肠代输尿管治疗腹膜后纤维化引起肾积水的疗效观察

The ileal replaced ureter with the antirefluxing technique for the treatment of hydronephrosis caused by retroperitoneal fibrosis

目的探讨运用抗反流技术的回肠代输尿管术治疗腹膜后纤维化引起的肾积水的价值。方法腹膜后纤维化所致长段输尿管狭窄和肾积水患者11例，其中双侧肾积水9例，单侧肾积水2例，均采用一段回肠替代双侧或单侧输尿管，输尿管与回肠作端侧吻合，并采用回肠壁外与腰大肌间隧道抗反流技术，固定段长4～5cm。结果11例患者术后均恢复良好，随访12～76个月，术后3个月静脉尿路造影显示肾积水明显减轻，术后半年肾积水基本消失，血生化、电解质正常。结论回肠替代输尿管时采用回肠壁外隧道抗反流技术是治疗腹膜纤维化引起的肾积水的较好术式，具有操作简单、抗反流效果良好、术后并发症少等优点。

Objective To explore the value of a new antirefluxing technique of segmental replacement of ureter with ileal in the treatment of hydronephrosis caused by retroperitoneal fibrosis. Methods Eleven cases with hydronephrosis caused by retroperitoneal fibrosis, 9 bilateral and 2 unilateral, were treated by using the ileal ureter with proximal antirefluxing technique. The ureter and ileal were connected by using end-to-side anastomosis, and the antirefluxing valve was constructed by fixing the distal part of the ureter （4 - 5 cm） between psoas muscle and ileal segment （the ileo-psoas tunnel）. Results The 11 cases were followed 12 - 76 months after the operation. Hydronephrosis improved dramatically at 3 months after operation and disappeared after 6 months postoperatively. The renal function recovered to normal. Conclusion The ileal replaced ureter with the ileo-psoas tunnel antirefluxing technique is recommended for treatment of hydronephrosis caused by retroperitoneal fibrosis.