经皮肾通道顺行输尿管软镜技术处理回肠输出道术后输尿管回肠吻合处狭窄的临床应用

Clinical application of percutaneous anterograde flexible ureteroscopy in the treatment of uretero ileal anastomotic stricture after Bricker's surgery

目的探讨经皮肾通道顺行输尿管软镜技术处理回肠输出道术后输尿管回肠吻合处狭窄的有效性及安全性。方法回顾性总结2017年1月至2019年12月,同济医院泌尿外科收治的16例膀胱根治性切除结合回肠输出道术后发生输尿管回肠吻合处狭窄梗阻的患者,采用经皮肾通道顺行输尿管软镜联合输尿管硬镜的术式行腔内手术治疗。术后3 d复查腹部平片及泌尿系CT以检查输尿管支架管位置及肾积水情况,术后7 d复查血肌酐以检查肾功能恢复情况。术后2~3个月后经回肠输出道造口拔除输尿管支架管,每3个月复查1次,随访12个月。结果共进行18侧手术,17侧顺利完成,1侧因输尿管迂曲角度过大而未能完成手术;所有手术患者未出现严重并发症,有3例出现发热,9例患者术后出现短暂持续性血尿;手术时间为35~130 min,平均(53.7±16.5)min。术后3 d复查腹部平片及泌尿系CT,患侧肾积水均有不同程度缓解。术后随访12个月,13侧在随访期内患侧肾积水无明显加重,肾功能持续稳定。术后随访中有4侧出现狭窄复发,复发时间在术后4~6个月。结论经皮肾通道顺行输尿管软镜联合输尿管硬镜处理回肠输出道术后输尿管回肠吻合处狭窄具有较好的临床应用价值。

Objective To explore the efficacy and safety of percutaneous anterograde flexible ureteroscopy in the treatment of uretero ileal anastomotic stricture after Bricker's surgery.Methods The clinical data of 16 patients with stricture and obstruction of uretero ileal anastomosis after radical cystectomy combined with ileal outflow tract surgery treated during Jan.2017 and Dec.2019 were retrospectively summarized.The patients were treated by percutaneous anterograde flexible ureteroscopy combined with retrograde ureteroscopy.KUB and urinary CT were reexamined 3 days after operation to check the position of ureteral stent and hydronephrosis.Serum creatinine was reexamined 7 days after operation to check the recovery of renal function.After 2-3 months,the ureteral stent was removed through ileostomy.The patients were reexamined every 3 months,and followed up for 12 months.Results A total of 18 operations were performed,17 of which were successfully completed,and 1 failed due to too large ureteral tortuosity angle.No serious complications were observed.Fever occurred in 3 patients and transient persistent hematuria occurred in 9 patients;The operation time was 35-130 min,average(53.71±16.5)min.The abdominal plain film and urinary CT 3 days after operation showed that the hydronephrosis of the affected side was alleviated in varying degrees.During the follow-up of 12 months,the hydronephrosis had no obvious aggravation in 13 cases,and the renal function remained stable.Stenosis recurred on 4 sides 4 to 6 months after operation.Conclusion Percutaneous anterograde flexible ureteroscopy combined with retrograde ureteroscopy has good clinical application value in the treatment of ureteral ileal anastomotic stricture after Bricker's surgery.