CAJ | 학술논문

目的总结输尿管长段撕脱伤的处理方法.方法输尿管撕脱伤患者4例,男3例,女1例,年龄32～45岁.其中输尿管上段结石3例,患肾轻至中度积水;上尿路血尿1例,患肾无梗阻表现.术前IVU检查患肾均显影.4例分别在硬膜外麻醉下行输尿管镜取石和检查手术,术中发生肾盂输尿管连接部和输尿管上段至膀胱的全层袖套状撕脱,长20～25 cm,平均24 cm.结果 4例患者均急诊改全麻下手术,行回肠输尿管替代术2例,撕脱输尿管复位吻合、大网膜包裹术1例,患肾切除术1例.2例回肠输尿管替代术患者术后恢复满意,无肾功能受损、代谢性酸中毒及反复尿路感染和排尿不适,1例随访13年,患肾形态及功能正常;1例随访3年,术后2年近端吻合口狭窄,行经皮肾狭窄扩张后好转;1例输尿管复位吻合患者,拔出支架管后3个月复查B超见患肾萎缩,肾图检查示功能丧失,行肾切除;1例伤后即行肾切除患者定期随访,血压、肾功能正常.结论输尿管镜手术发生输尿管长段撕脱伤在无可用的尿路进行重建时,回肠输尿管替代是-可选择的术式,其疗效可靠,预后好.
목적 총결수뇨관장단시탈상적처리방법.방법 수뇨관시탈상환자4례,남3례,녀1례,년령32～45세.기중수뇨관상단결석3례,환신경지중도적수;상뇨로혈뇨1례,환신무경조표현.술전IVU검사환신균현영.4례분별재경막외마취하행수뇨관경취석화검사수술,술중발생신우수뇨관련접부화수뇨관상단지방광적전층수투상시탈,장20～25 cm,평균24 cm.결과 4례환자균급진개전마하수술,행회장수뇨관체대술2례,시탈수뇨관복위문합、대망막포과술1례,환신절제술1례.2례회장수뇨관체대술환자술후회복만의,무신공능수손、대사성산중독급반복뇨로감염화배뇨불괄,1례수방13년,환신형태급공능정상;1례수방3년,술후2년근단문합구협착,행경피신협착확장후호전;1례수뇨관복위문합환자,발출지가관후3개월복사B초견환신위축,신도검사시공능상실,행신절제;1례상후즉행신절제환자정기수방,혈압、신공능정상.결론 수뇨관경수술발생수뇨관장단시탈상재무가용적뇨로진행중건시,회장수뇨관체대시-가선택적술식,기료효가고,예후호.
Objective To summarise the methods for a long segmental avulsed inj ury of ureter.Methods Ureteroscopies were performed on three male patients with upper ureteral calculi and one female patient with haematuria from upper urinary tract.Ureteral calculi caused small and middle hy-dronephrosis,obstruction wasn't seen on the upper urinary tract with haematuria.The kidney on the affected side showed normal founction on IVP.Four patients were suffered from a long segmental avulsed inj uries of full-thickness of ureter from ureteroscopy in a continuous epidural anesthesia.The injuries took place in UPJ and upper ureter.The length of avutsed ureters is 20-25 cm,mean length is 24 cm. Results The ureteroscopies were altered to open operations which were ileal ureteral substi-tutions on two patients,being anastomosed the avulsed ureter wrapped by caul on one patient and nc-phrectomy on one patient under general anesthesia in an emergercy.Two ileal ureteral substitutions had reached satisfied results that were no damaged renal functions,no metabolic acidosis,no repeatly U-rinary tract infections and no complains about micturition.One patient has maintained normal renal morphology and function after thirteen years followup,the other formed stricture in the anastomosis of the proximal piece of-ileum to the renal pelvis tWO years after operation,and then improved after ante-grade dilation.The patient with being replaced back and anastomosed the avulsed ureter had compli-cated with a renal atrophy on the affected side three months after the double-J was extracted.The kid-ney showed no function on isotop nephrogram and then was ablated.The last one with nephrectomy and the one before were followed up regularly,the renal functions and blood pressures remain normal.Conclusion Ileal ureteral substitution would be a good choice and has a stable curative effect and provide a good prognosis for treating long segmental avulsed injury of ureter suffered from ureterosco PY when no available urinary tract was utilized for reconstruction.