输尿管镜手术相关输尿管全长离断的急诊原位再植修复4例报告

In situ emergent replantation repair of ureteroscopy-related full-length ureteral avulsion:A report of 4 cases

目的探讨原位再植修复用于输尿管镜相关输尿管全长离断急诊修复的临床疗效,为此类严重并发症的治疗提供借鉴。方法回顾性分析上海4家综合性医院近5年诊治的输尿管镜相关输尿管全长离断行急诊原位再植修复的4例患者的临床资料,术式均采用近端输尿管端端吻合+远端输尿管膀胱再植术,统计分析4例患者的围手术期及随访的相关指标。结果4例患者平均手术时间为(4.75±0.65)(4.0~5.5)h,术中行大网膜包绕3例(75%),术中行经皮肾造瘘2例(50%),中位随访时间为24(6~54)个月,双J管平均留置时间为(6.75±1.89)(4~8)个月,肾造瘘管平均留置时间为(7.25±11.41)(0~24)个月,围手术期及随访肾功能及肾积水程度总体稳定。结论对于输尿管镜相关输尿管全长离断,实施以输尿管端端吻合+输尿管膀胱再植术为基础的急诊原位再植修复能够恢复输尿管的自然结构与生理功能、有效保护肾功能,有望成为同等条件下的首选急诊修复方法。

Objective To investigate the clinical efficacy of in situ emergent replantation repair of ureteroscopy-related full-length ureteral avulsion and to provide a reference for the treatment of such serious complications.Methods The clinical data of 4 cases of ureteroscopy-related full-length ureteral avulsion repaired by in situ emergent replantation in 4 comprehensive hospitals in Shanghai in the past 5 years were anayzed.Proximal end-to-end ureteroureterostomy combined with distal ureteroneocystostomy was performed in all cases.Perioperative and follow-up parameters were analyzed.Results The average operation time was(4.75±0.65)(4.0-5.5)h.Greater omentum investment was performed in 3 cases(75%),and 2 cases(50%)were treated with percutaneous nephrostomy.The median follow-up time was 24(6-54)months.The average double-J stent indwelling time was(6.75±1.89)(4-8)months and the average nephrostomy duration was(7.25±11.41)(0-24)months.The renal function and hydronephrosis of all patients were generally stable during the perioperative period and follow-up.Conclusion On the equal conditions,in situ emergent replantation repair based on end-to-end ureteroureterostomy and ureteroneocystostomy should be given priority to,for it can restore the natural structure and physiological function of ureter and effectively protect the renal function.