尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

Endoscopic treatment of benign ureterointestinal anastomotic strictures in patients with urinary diversion

目的探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值。方法膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例，狭窄段长度1～3cm，均采用腔内技术治疗，顺行经皮肾处理8例，逆行输尿管镜处理1例；术中使用高压气囊配合筋膜扩张器扩张，术后留置双J管。结果随访0．5～5．0年。1例吻合口闭锁患者术后3个月仍为重度积水，患者拒绝开放手术而长期留置肾造瘘管；8例患者肾积水减轻，再次逆行扩张狭窄段并留置双J管，其中5例经2～3次扩张换管，拔除双J管后复查肾积水稳定于轻度状态；3例拔除双J管后腰痛不适，需要长期留置双J管。结论尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好，可避免开放手术的风险。

Objective To evaluate the clinical efficacy of endourologic treatment of benign ureterointestinal anastomotic strictures in patients with urinary diversion. Methods Nine cases of benign ureterointestinal anastomotic strictures with a length of 1--3 cm following radical cystectomy and urinary diversion accepted endourologic treatment. 8 cases were treated by antegrade percutaneous approach, 1 case by retrograde ureteroscopic approach. The strictures received balloon dilation, and ureteral stents indewelled. Results In a follow up of 0.5--5.0 years, 1 case received percutaneous nephrostomy for complete ureterointestinal anastomotic atresia and refused to open operation reconstruction. 5 cases had no recurrence after 2-- 3 endoscopic sessions. 3 cases needed long time ureteral stents indwelled. Conclusion Endourological technique for ureterointestinal strictures following urinary diversion avoided the disadvantages of open operation.