腹腔镜下膀胱翻瓣成形治疗高位输尿管撕脱伤的疗效观察

Clinical observation of laparoscopic bladder flap forming in the treatment of upper ureteral avulsion

目的评估腹腔镜下膀胱翻瓣成形治疗高位输尿管撕脱伤(输尿管撕脱长度>10cm)的临床疗效及安全性。方法回顾性分析2014年11月至2016年5月浙江省人民医院泌尿外科收治的输尿管撕脱伤患者4例,均于外院行输尿管镜碎石过程中发生输尿管高位撕脱,其中2例患者分别行输尿管造瘘、肾盂造瘘后转至我院,另外2例留置导尿管后直接转至我院;所有患者均采用腹腔镜下膀胱肌瓣替代缺损的输尿管进行治疗,术中采用带蒂大网膜覆盖吻合处,记录术中及术后并发症,并收集患者术后3~18个月的复查资料,包括肾功能、泌尿系B超或CT、分肾功能检查(ECT)。结果所有手术均一次顺利完成。平均手术用时104min,术中出血量平均为109mL。围手术期内无尿漏、肾绞痛、高热等并发症发生。在术后3~18个月的随访期内,患者的肾功能、肾盂分离程度均未发生明显变化。2例输尿管上段撕脱伤的患者术后3个月拔除双J管;另2例行输尿管或肾盂造瘘的患者均于术后3个月更换双J管,其中1例于术后6个月彻底拔除双J管。随访期内2例患者存在偶尔患侧腰酸、4例患者均无急性肾盂肾炎、肾积水加重、吻合口狭窄、肾萎缩发生。结论腹腔镜下膀胱翻瓣成形是治疗高位输尿管撕脱伤(输尿管撕脱长度>10cm)一种安全有效的治疗方法,具有创伤小、恢复快、并发症少等优点。

Objective To evaluate the safety and efficacy of laparoscopic bladder muscle flap reconstruction in the treatment of upper ureteral avulsion（length10 cm）.Methods The clinical data of 4 patients with upper ureteral avulsion treated during Nov.2014 and May2016 were retrospectively reviewed.All avulsions occurred in other hospitals during ureteroscopy lithotripsy.Before referral,2 cases had undergone ureteral fistula and the other 2 had had catheter indwelt.All patients were treated with laparoscopic ureteral muscle flap reconstruction and pedicled omental covering the anastomosis.Intraoperative and postoperative complications were recorded.The kidney function,urinary ultrasound or CT,sub-renal function tests（Emisson computed tom ography（ECT）3 and 18 months after operation were analyzed.Results All operations were successful.The average operation time and blood loss was 104 min and 109 mL,respectively.No urinary leakage,renal colic,fever or other complications occurred perioperatively.No significant changes of renal function and renal pelvis separation were observed.DJ tube was removed from2 cases of upper ureteral avulsion3 months postoperatively.For the other 2 patients with ureteral fistula,one had DJ tube removed 6 months postoperatively,and the other had it changed 3 months postoperatively.In the followup of 3-18 months,occasional backache affected two patients,but no patient had acute pyelonephritis,hydronephrosis progression,anastomotic stenosis or renal atrophy.Conclusion Laparoscopic bladder flap forming is a safe and effective treatment with small trauma,quick recovery,few complications for upper ureteral avulsion.