良性输尿管狭窄的治疗:90例单中心回顾分析

Treatment of benign ureteral stenosis:retrospective analysis of 90 cases in single-center

目的 回顾分析良性输尿管狭窄的病因及治疗效果。方法 分析清华长庚医院2014年12月至2018年2月收治的良性输尿管狭窄病例资料。狭窄段病变根据长度(单位:cm)不同分为A (χ≤1)、B(1<χ≤2)、C(χ>2)3组。所有患者均行内镜手术治疗或开放/腹腔镜狭窄段切除再吻合等尿路重建成形手术。结果 狭窄病变总共治疗117侧,其中86侧行内镜治疗,总体有效率为45.3%;31侧行开放/腹腔镜输尿管成形术,有效率为80.6%,明显高于内镜手术(P=0.01)。A、B、C三组内镜治疗的有效率分别为51.3%、44.1%、30.8%,差异无统计学意义(P=0.43)。结论 开放/腹腔镜输尿管成形术治疗良性输尿管狭窄的有效率明显高于内镜手术。选择合适的病例,内镜手术可作为良性输尿管狭窄治疗的首选方案。即使内镜治疗失败,二期开放/腹腔镜输尿管成形术仍可取得满意的效果。

Objective To retrospectively analyze the etiology and treatment effects of ureteral stenosis.Methods The clinical data of patients with benign ureteral strictures admitted to Beijing Tsinghua Changgung Hospital from December 2014 to February 2018.Patients were divided into 3 groups according to the length of stenotic lesions(unit:centimeter):group A(χ≤1),group B(1<χ≤2)and group C(χ>2).All patients underwent endoscopic surgery or open/laparoscopic resection of stenosis site and re-anastomosis and other urinary tract reconstruction operations.Results There were 117 sides of stenosis treated.The methods were endoscopy and open/laparoscopic ureteroplasty.The effective rate of endoscopic treatment was 45.3%and 80.6%for open/laparoscopic ureteroplasty.The effective rate of open/laparoscopic surgery is higher than that of the endoscopic treatment(P=0.01).The effective rate in group A,B and C was 51.3%,44.1%and 63.3%respectively and there was no significant difference among them(P=0.43).Conclusions Open/laparoscopic ureteroplasty is more effective than endoscopic treatment of benign ureteral stenosis.For some proper cases of ureteral stricture,endoscopic surgery can be the first choice of treatment.Even if the endoscopic surgery fails,open/laparoscopic ureteroplasty can still be performed in the second stage,and the treatment effect is satisfactory.