近端抗反流技术回肠代输尿管术后患者的长期疗效观察

Long-term outcome of ileal ureter replacement with proximal antirefluxing technique

目的观察采用近端抗反流技术的回肠替代输尿管治疗长段输尿管狭窄或缺损患者的长期疗效。方法1997年1月至2011年12月收治31例输尿管长段狭窄或缺损（15～25cm）和3例输尿管中下段癌，切除输尿管范围从膀胱到距肿瘤上方5～8em的输尿管。男23例，女11例。双侧19例，单侧15例。采用近端抗反流技术的回肠替代输尿管治疗。输尿管与回肠近端做端侧吻合，回肠两侧壁夹着输尿管固定在腰大肌上，固定段长4cm左右，回肠远端与膀胱做端侧吻合。术后随访包括检测肾功能、电解质，肾、输尿管、膀胱超卢和x线检查。结果34例患者术后随访12～180个月，平均67个月。术后6个月静脉肾盂造影显示‘肾积水明显减轻或基本消失25例，改善9例；膀胱造影示无回肠输尿管反流；3例需长期口服碱性药物，以防高氯性酸中毒；3例输尿管癌中1例于术后3年死于肿瘤远处转移，余2例术后已分别随访11年和15年，无不适症状。结论回肠替代输尿管时采用回肠壁外隧道近端抗反流技术具有抗反流效果好、术后并发症少的优点，是治疗输尿管长段狭窄或缺如的较好术式。

Objective To investigate the long-term outcome of ileal ureter replacement with proximal antirefluxing technique. Methods Thirty-four cases with a long uteter stricture or defect （ 15-25 cm） and cancer of middle and lower ureter （ resected ureter ranged from bladder to 5- 8 cm above the tumor） （ male 23 and female 11 ; bilateral 19 and unilateral 15） , were treated by ileal ureter replacement with proxi- mal antirefluxing technique, in which the ureter was replaced with a segment of ileum using an end-to-side anastomosis. The distal part of upper ureter （4 cm） was fixed between the psoas muscle and ileal segm6nt （the ileo-psoas tunnel technique）. The distal ileum was connected to the urinary bladder withpan end-to-side anastomosis. Serum electrolyte, creatinine and blood urea nitrogen （BUN） ; ultrasonography and radiograph- ic investigations of urinary system were recorded during follow up. Results The 34 cases were followed for 12-180 months （mean, 67 months）. The intravenous urography showed that the hydronephrosis improved significantly or diseapeared by a^sessed after 6 month in 25 patients, 9 had improvement. Cystography showed no evidence of ileo-ureteral reflux. Three patients needed oral alkalization because of prevention of hyperchloremie acidosis. Among the 3 patients with ureter cancer, 1 patient died after 3 years because of metastasis and the other 2 patients were well without cancer currence after follow up of 11 and 15 years postop- eratively. Conclusion In our experience, ileal ureteral replacement with the ileo-psoas tunnel anti-refluxing technique is a highly effective procedure for the treatment of long segment ureteral strictures and defect.