输尿管长段撕脱伤3例报道及防治分析

Long Segment Ureteral Avulsion: Report of 3 Cases and Analysis of Prevention and Treatment

目的对3例输尿管长段撕脱的患者进行回顾性分析,旨在为输尿管长段撕脱伤的预防及治疗提供可参考的建议。方法收集2014年至2016年浙江大学医学院附属第一医院收治的输尿管长段撕脱患者的临床资料并进行回顾性分析。结果 1号患者行回肠代左输尿管术,术后1个月查IVU提示患侧显影正常,未见异常狭窄及尿外渗,B超提示患侧肾轻中度积水;术后3个月,拔除双J管时,CT检查提示左肾及输尿管上段积水。2号患者输尿管撕脱后8小时急诊行腹腔镜膀胱瓣成形输尿管吻合术,术后2个月复查B超提示右肾轻度积水;术后3个月患者无尿频症状,复查CT检查提示右肾轻度积水,复查IVU提示患侧显影正常,未见异常狭窄及尿外渗,行输尿管软镜探查术,术中可见输尿管全程通畅,无狭窄,原膀胱、输尿管吻合处伤口愈合佳、无狭窄。3号患者撕脱后1个月行腹腔镜膀胱瓣成形输尿管吻合术,术后3个月拔除双J管,术后3个月查IVU提示患侧显影正常,未见异常狭窄及尿外渗,CT检查提示患侧肾无积水。结论针对输尿管长段撕脱伤重在预防,在输尿管镜手术中术者应规范操作,切忌使用暴力。当输尿管长段撕脱伤已然发生时,早期行回肠代输尿管术或膀胱瓣成形输尿管吻合术都是良好的可选补救措施。

Objective To provide reference for the prevention and treatment for the long segment ureteral avulsion. Methods A retrospective analysis was made on the clinical data of three patients with long segment ureteral avulsion who were treated in the authors' hospital from 2014 to 2016. Results Patient 1 was underwent ileal ureter substitution. The IVU showed no ureteral stricture and urinary extravasation and the Beta-ultrasound exam showed moderate left hydronephrosis one month postoperatively. 3 months postoperatively,the D-J tube was removed. CT scan also showed the moderate left hydronephrosis. Patient 2 underwent laparoscopic ureteral reconstruction using bladder flap within 8 hours after avulsion. The results showed that there was mild right hydronephrosis after 2 months. After 3 months,CT scan also showed mild right hydronephrosis. IVU showed that the affected side developed normally,and there was no abnormal stricture and urinary extravasation. And the patient had no symptoms of frequent micturition. Flexible ureteroscopy showed that the ureter was unobstructed,and no stricture was found during the examination. The wound healed well in the area of the former anastomosis of bladder and ureter. Patient 3 were also treated by laparoscopic ureteral reconstruction using bladder flap within 1month after avulsion. The D-J tube was removed after 3 months after the operation. IVU showed normal development,and there is no abnormal stricture or urinary extravasation in the affected side. CT scan also suggested that there was no hydronephrosis in the affected side. Conclusions To the long segment ureteral avulsion,prevention should be primarily emphasized. In the ureteroscopy lithotomy,operation should be standardized and excessive force should not be used. When the long segment ureteral avulsion has already occurred,it is a reasonable optional remedy that the operation of ileal ureter substitution or ureteral reconstruction using bladder flap.