经皮顺行输尿管镜治疗输尿管肠代膀胱吻合口狭窄

Percutaneous Ureteroscope for Ureterointestinal Anastomotic Strictures

目的:探索顺行输尿管镜治疗输尿管肠代膀胱吻合口狭窄的有效性、安全性。方法:11例输尿管肠代膀胱吻合口狭窄患者,年龄55～78岁(平均62岁),均为膀胱癌全膀胱切除术后。采用MRU检查确诊存在输尿管肠代膀胱吻合口狭窄。行经代膀胱逆行输尿管插管均未获成功。行微创经皮肾穿刺及顾行输尿管镜,留置导丝并用输尿管镜扩张、冷刀内切开,留置F7双J管4～6周拔除,并定期随访肾积水、肾功能变化。结果:所有病例均手术成功。无严重术后出血,1例患者发生急性肾盂肾炎。3例伴肾功能不全患者术后6个月肾功能恢复正常。术后3个月、6个月及12个月随访B超,7例患者肾积水减轻,3例患者肾积水无加重,1例患者左肾积水加重。结论:经皮顺行输尿管镜治疗输尿管肠代膀胱吻合口狭窄是安全、有效的方法。

[ABSTRACT] Objective：To evaluate the validity of percutaneous ureteroscope in the treatment of ureterointestinal anastomosis strictures after urinary diversion,Methods： All the I l patients（55-78 years old） underwent MRU for diagnosis.All of them received percutaneous ureteroscope and Cold-knife endoureterotomy for ureterointestinal anastomotic strictures.A 7F stent was left indwelling for 4 to 6 weeks.Results： All the cases underwent the operation successfully.No severe bleeding occurred.One ease underwent pyelonephritis after the operation.3 cases with renal dysfunction recovered in 6 months after the opration.All the patients were followed up for 3 months to 12 months, the ultrasound sonography showed resolution of hydronephrosis of the diseased kidneys in 7 cases and no progress in 3 cases. Conclusions： Percutaneous ureteroscope for ureterointestinal anastomotic strictures is secure and effective.