输尿管软镜处理Bricker术后吻合口狭窄

Application of Flexible Ureteroscope in the Treatment of Ureterointestinal Anastomotic Strictures in Patients with Bricker Urinary Diversion

目的评价顺行输尿管软镜钬激光狭窄段内切开术治疗Bricker术后输尿管-肠吻合口狭窄的临床价值及安全性．方法收集2009年3月至2012年8月行全膀胱切除＋Bricker术后发生输尿管-肠吻合口狭窄的患者6例．平均年龄为（61±7）岁．平均首次就诊时间为术后（6．3±2．5）个月．左侧4例，右侧2例．患者一期行患侧经皮肾造瘘术（PCN术），二期行顺行输尿管软镜下激光狭窄段内切开术，合并结石者一同处理结石．术前通过B超、CT、KUB＋IVP、顺行尿路造影检查明确梗阻部位．狭窄段长度0．4～2．5cm，平均0．9cm．术后常规留置F6双J管12周．拔除双J管后复查KUB＋IVP．结果平均手术时间为（53±8）min，平均住院时间为（5．5±2）d，术中出血量3～6mL．随访时间为6—30个月，中位随访时间为18个月．5例均未见狭窄复发；1例再次出现狭窄，行顺行输尿管软镜下钬激光狭窄段内切开术，每12个月定期更换双J管．结论顺行输尿管软镜下钬激光内切开术处理Bricker术后输尿管-肠吻合口狭窄安全、有效、手术并发症少．

Objective To evaluate the clinical efficacy and safety of application of anterograde flexible ureteroscope in the treatment of ureterointestinal anastomotic strictures in patients after Bricker urinary diversion. Methods From March 2009 to July 2012, 6 patients with ureterointestinal anastomotic strictures after Bricker procedure were enrolled in this study. The average age of the patients was （61 ±7） years old. The first clinical presentation was averagely （6.3 ±2.5） months after the Brieker procedure. There were 4 cases with left side strictures and 2 eases with right side ones. The urinary tract ultrasound, CT, KUB＋IVP and antegrade urography were carried out to identify the obstructive portion. The mean length of stricture was 0.9cm （0.4-2.5） . First, all patients underwent percutaneous nephrostomy （PCN） , then inside incision by Holmium： YAG laser under anterograde flexible ureteroscopy and lithotripsy （with calculi） . The F6 double J ureteral stent was indweller for 12 weeks. KUB＋IVP was performed after removal of double J ureteral stents. Results The mean operative time was （53 ±8） min. The mean hospital stay was （5.5 ±2） days. The blood loss was 3 - 6 mL. The average follow-up was 18 months （6 -30） . No recurrence was found in 5 patients. One case had recurrent stricture after the first procedure, which was successfully managed by the flexible ureteroscopy again and replacing double J ureteral stent every 12 months. Conclusion The inside incision by anterograde flexible ureteroscopic Holmium： YAG laser is safe and effective for ureterointestinal anastomotic strictures in patients after Bricker urinary diversion, with less complications.