螺旋状带蒂膀胱肌瓣修复长段输尿管缺损的疗效分析

Curative effect of using spiral pedunculated bladder muscle flap in long ureteral segment defect repairing

目的探讨螺旋状带蒂膀胱肌瓣输尿管成形术治疗长段（〉20cm）输尿管缺损的方法及疗效。方法回顾性分析采用螺旋状带蒂膀胱肌瓣输尿管成形术治疗5例肾盂输尿管连接处狭窄合并结石，行输尿管镜下碎石术操作过程中因套篮取石或碎石后退镜等发生的长段输尿管缺损患者的临床疗效。5例患者中男3例，女2例；年龄37～59岁，平均48岁；左侧4例，右侧1例。其中输尿管黏膜全程撕脱2例，自肾盂至膀胱连接处输尿管完全离断3例；缺损长度21—25cm，平均22cm。5例均急诊行螺旋状带蒂膀胱肌瓣输尿管成形术，同时行患侧膀胱腰大肌固定，成形输尿管内置7F双J管，新建输尿管平均长度22cm。结果5例手术顺利。手术时间1～2h，平均1．5h。术后成形输尿管旁引流管第3天拔除4例，1例因漏尿于术后第10天拔除。5例切口均一期愈合。术后2周复查血肌酐和尿素氮指标正常，术后8周在膀胱镜下安全拔除双J管。1例术后6个月复查时发现手术侧轻度肾积水及输尿管轻度扩张，但总肾功能正常；4例随访2～4年未见明显异常，IVU检查显示手术侧成形输尿管形态均正常，显影良好。结论螺旋状带蒂膀胱肌瓣输尿管成形术是长段输尿管损伤修复的理想术式，有较高的推广价值。

Objective To investigate the effects of using spiral pedunculated bladder muscle flap ureteroplasty in the treatment of long ureteral segment defects （ 〉 20 cm）. Methods A retrospective a- nalysis was conducted on the clinical effects of five patients who encountered long ureteral segment defects caused during ureteroscopic lithotripsy. The five patients included three males and two females with an age range from 37 to 59 yrs （ average age 48）. Four of the cases had defects on the left and one case on the right. Two cases had whole ureteral mucosal avulsion and three cases had whole ureteral ruptur from the pel- vis to the bladder junction. Defect lengths measured from 21 to 25 cm （mean length 22.5 cm）. All five patients underwent emergency surgery using spiral pedunculated bladder muscle flap ureteroplasty and 7 F double J stent placement in the repaired ureters which was fixed on psoas muscles. The average length of the new ureters using spiral pedunculated bladder muscle flap was 22.5 cm. Results All the operations were successful and the operation time was 1 - 2 hrs （ average 1.5 hrs）. Drainage tubes for four patients were removed three days after operation. IN the remaining case the drainage tube was removed 10 days after surgery due to urine leakage. All wounds healed uneventfully. Serum creatinine and blood urea nitrogen were normal two weeks after surgery. Double-J tubes were removed safely under cystoscope eight weeks after surgery. In following-up, one case was found to have mild hydronephrosis and ipsilateral ureter slight expansion six months after surgery, but renal function was normal. There was no abnomality found in the remaining four patients after 2 - 4 years of follow-up. The IVU showed normal morphology and good developments in the ipsilateral ureter. Conclusions Spiral pedunculated bladder muscle flap ureteroplasty is an ideal treatment method in repairing long ureteral segment defects.