口腔黏膜补片在输尿管狭窄重建中的应用效果

Clinical effect of oral mucosal patches in the reconstruction of ureteral stenosis

目的观察口腔黏膜补片在复杂性输尿管狭窄重建中的应用效果。方法回顾性分析2019年5月至2023年5月安徽医科大学第二附属医院收治的28例输尿管狭窄患者的临床资料,记录手术前后肾功能、肾盂分离度等指标并分析手术疗效。结果28例患者中,男15例,女13例,平均年龄(48.00±12.23)岁;狭窄长度为2.75(2.00,3.75)cm,狭窄重建手术平均用时(228.68±59.85)min,术中失血25.00(20.00,30.00)ml;手术方式方面,有24例腹腔镜手术,4例机器人辅助手术;手术材料方面,有17例舌黏膜补片,10例颊黏膜补片,1例舌黏膜+颊黏膜补片;手术技术类型方面,有24例切开吻合,4例后壁加强。术前中位尿素氮、肌酐、胱抑素C分别为6.81(5.44,7.77)mol/L、82.00(66.50,111.25)μmol/L、1.19(0.70,1.58)mg/L,术前肾盂分离度32.50(25.50,43.90)ml。术后中位尿素氮、肌酐、胱抑素C、肾盂分离度分别为5.20(4.72,6.79)mol/L、77.50(64.50,97.50)μmol/L、1.05(0.77,1.20)mg/L、17.50(13.25,23.50)mm,均较术前显著降低(P<0.05);术后3~6个月有效率为92.86%(26/28)。结论口腔黏膜补片输尿管成形术临床效果较好,是治疗长段、复杂性输尿管狭窄的可靠选择,期待多中心、大样本及长期随访进一步验证。

Objective To observe the effectiveness of oral mucosal patches in the reconstruction of longsegment,complex ureteral strictures.Methods The clinical data of 28 patients with ureteral stenosis who were treated in the Second Affiliated Hospital of Anhui Medical University from May 2019 to May2023 were retrospectively analyzed,and indicators such as renal function and renal pelvis separation before and after surgery were recorded,and the surgical efficacy was analyzed.Results Of the 28patients,15 were male and 13 were female with a mean age of(48.00±12.23)years old.The median stenosis length was 2.75(2.00,3.75)cm,the average time for stenosis reconstruction surgery was(228.68±59.85)min,and intraoperative blood loss was 25.00(20.00,30.00)ml.In terms of surgical approach,there were 24 laparoscopic surgeries and 4 robotic-assisted surgeries;in terms of surgical materials,there were 17 cases of lingual mucosal patch,10 cases of buccal mucosal patch,and 1 case of lingual mucosal+buccal mucosal patch;as for the type of surgical technique,there were 24 cases of incisional anastomosis and 4 cases of posterior wall reinforcement.Preoperative urea nitrogen,creatinine,and cystatin C were 6.81(5.44,7.77)mol/L,82.00(66.50,111.25)μmol/L,and 1.19(0.70,1.58)mg/L,respectively,and preoperative pyeloidal separation was 32.50(25.50,43.90)ml.Postoperative urea nitrogen,creatinine,cystatin C,and median renal pelvis separation were 5.20(4.72,6.79)mol/L,77.50(64.50,97.50)μmol/L,1.05(0.77,1.20)mg/L,and 17.50(13.25,23.50)mm,respectively,all of which were significantly reduced compared with those of the preoperative period(P<0.05).The effective rate was 92.86%(26/28)at 3-6 months postoperatively.Conclusions Oral mucosal patch ureteroplasty has better clinical results and is a reliable option for the treatment of long-segment,complex ureteral strictures,and further validation with multicenter,large samples and long-term follow-up is expected.