膀胱粘膜肌瓣翻转术在抗膀胱输尿管返流术中的应用(附四例报告)

Treating vesicoureteral reflux with reversed vesical muco-muscular flap (report of 4 cases)

目的 提高治疗膀胱输尿管返流的手术疗效。 方法 采用膀胱粘膜肌瓣翻转抗返流术治疗膀胱输尿管返流 4例 ,其中因输尿管壁段结石行经尿道输尿管口切开致膀胱输尿管返流 2例 ,原发性膀胱输尿管返流 2例。Ⅲ°1例 ,Ⅳ°3例。 结果 术后 2例出现膀胱刺激症状及膀胱痉挛 ,1个月后症状明显改善 ,3个月后症状完全消失。 4例平均随访 2 2个月 ,患者症状消失 ;IVU示患侧肾功能良好 ,3例肾积水及输尿管扩张完全消失 ,1例改善 ;膀胱造影均未见膀胱输尿管返流 ;膀胱镜可见再造输尿管口呈唇状。 结论 膀胱粘膜肌瓣翻转抗返流术治疗膀胱输尿管返流简便、有效 ,但存在术后膀胱刺激症状重的缺点。

ObjectiveTo evaluate the efficiency of reversed vesical muco-muscular flap in the treatment of vesicoureteral reflux.MethodsFrom 1999 to 2000,a new anti-reflux operation was performed for 4 cases of vesicoureteral reflux (one with grade Ⅲ and three with grade Ⅳ) using reversed vesical muco-muscular flap.The vesicoureteral reflux was primary in 2 patients and secondary to ureteromeatotomy for the management of intramural ureteral calculi in the other 2.ResultsAll the 4 patients were successfully treated with this new technique.2 patients exhibited bladder irritation and spasm after operation,which were palliated in one month and vanished in three months.The lumbodynia and distending pain vanished during the follow-up (mean 22 months). Intravenous urography revealed normal renal function of the involved kidney.Hydronephrosis and ureteric dilatation were cured in 3 patients and significantly improved in 1.Voiding cystography demonstrated no reflux.The reconstructed ureteral orifice was labiate under cystoscopic view.ConclusionsThe anti-reflux operation is simple,convenient and effective in the treatment of vesicoureteral reflux.The postoperative bladder irritation is transient and shortcoming.