经皮下肾盂膀胱分流术在输尿管梗阻中的应用(附3例报告)

Clinical Application of Subcutaneous Pyelovesical Bypass in Ureteral Obstruction: a Report of 3 Cases

本文报道3例经皮下肾盂膀胱分流术。B超引导下行患肾穿刺造瘘术,通过导丝置入肾膀胱分流导管的肾盂部分,将导丝另一端自肾造瘘处引出,自皮下用筋膜扩张器打出一隧道至耻骨上,通过隧道将分流导管引入皮下,于耻骨上2横指处行耻骨上膀胱造瘘,在膀胱镜指引下自造瘘处将支架管引入膀胱。3例手术顺利,手术时间分别为104、107、116 min。术后腰痛症状改善,血肌酐较术前下降明显(由术前758、552、232μmol/L分别下降至术后129、420、178μmol/L)。3例分别随访6、12、24个月,1例皮下软组织感染拔除分流管,2例因肿瘤转移死亡。我们认为经皮下肾盂膀胱分流术可以有效改善患肾功能,提高生活质量,是难治性输尿管梗阻患者的一种理想选择。

The paper reported 3 cases of subcutaneous pelvic-vesical bypass. Nephrostomy was performed under ultrasonography. The one side of the shunt catheter was introduced into the pelvis, while the other side of the tube was leaded into the bladder by fascia dilator subcutaneously. Cystostomy was performed and the location was defined by cystoscopy. The operations were completed successfully. The operation time was 104, 107, and 116 min, respectively. Back pain was relieved remarkably after surgery, and serum creatinine decreased significantly trom 758, 552, 232 μmol/L preoperatively to 129, 420, 178μmol/L postoperatively,respectively. After follow-ups for 6, 12, and 24 months, 1 case suffered from subcutaneous soft tissue infection and the shunt tube was removed then. 2 cases died of the primary tumor metastases. Subcutaneous pyelovesical bypass can improve the renal functions and the quality of life effectively. For refractory cases, it can be an ideal choice.