尿流改道术后输尿管肠吻合口狭窄的诊疗进展

Advances in diagnosis and treatment of ureteroenteric anastomotic stricture after urinary diversion surgery

根治性膀胱切除术联合尿流改道术是治疗肌层浸润膀胱癌的标准方案,输尿管肠吻合口狭窄(ureteroenteric anastomotic stricture,UES)是其术后常见并发症之一,可导致上尿路梗阻,严重者损害肾功能、影响预后。肥胖、既往手术史、既往放化疗史、机器人手术、尿流改道方式、输尿管肠吻合方法等诸多因素均与术后UES有关。术前识别危险因素可以帮助手术决策,术中的精细操作和术者丰富手术经验有助于降低UES风险,术后随访应全面评估影像学证据和肾功能情况以早期准确诊断UES并进行积极治疗。开放性手术修复依然是治疗UES金标准,机器人手术修复也展现出满意的UES控制率和安全性,腔内治疗可作为对于狭窄长度≤1 cm患者的一线选择。

Radical cystectomy combined with urinary diversion is the standard treatment for muscle-invasive bladder cancer.Ureteroenteric anastomotic stricture(UES)is a common postoperative complication,potentially leading to upper urinary tract obstruction,and in severe cases,deteriorating renal function and prognosis.Factors such as obesity,previous surgical history,prior history of radiotherapy or chemotherapy,robotic surgery,type of urinary diversion,and method of ureteroenteric anastomosis are associated with postoperative UES occurrence.Identifying risk factors preoperatively can aid in surgical decision-making,while meticulous intraoperative techniques and extensive surgical experience help mitigate UES risk.Postoperative follow-up should comprehensively assess imaging evidence and renal function to diagnose UES accurately and initiate prompt treatment.Open surgical repair remains the gold standard for UES treatment due to its high success rate and durable long-term patency rate.Robotic surgical repair also demonstrates satisfactory UES control rates and safety.Endoscopic treatment can serve as a first-line option for patients with stricture≤1 cm,yielding favorable functional outcomes and lower complication rates.