CAJ | 학술논문

目的：评价顺行输尿管软镜钬激光狭窄段内切开术治疗Bricker术后输尿管-肠吻合口狭窄的临床价值及安全性．方法收集2009年3月至2012年8月行全膀胱切除+Bricker术后发生输尿管-肠吻合口狭窄的患者6例．平均年龄为（61±7）岁．平均首次就诊时间为术后（6.3±2.5）个月．左侧4例，右侧2例．患者一期行患侧经皮肾造瘘术（PCN术），二期行顺行输尿管软镜下激光狭窄段内切开术，合并结石者一同处理结石．术前通过B超、CT、KUB+IVP、顺行尿路造影检查明确梗阻部位．狭窄段长度0.4～2.5 cm，平均0.9 cm．术后常规留置F6双J管12周．拔除双J管后复查KUB+IVP．结果平均手术时间为（53±8） min，平均住院时间为（5.5±2） d，术中出血量3～6 mL．随访时间为6～30个月，中位随访时间为18个月．5例均未见狭窄复发；1例再次出现狭窄，行顺行输尿管软镜下钬激光狭窄段内切开术，每12个月定期更换双J管．结论顺行输尿管软镜下钬激光内切开术处理Bricker术后输尿管-肠吻合口狭窄安全、有效、手术并发症少．
목적：평개순행수뇨관연경화격광협착단내절개술치료Bricker술후수뇨관-장문합구협착적림상개치급안전성．방법수집2009년3월지2012년8월행전방광절제+Bricker술후발생수뇨관-장문합구협착적환자6례．평균년령위（61±7）세．평균수차취진시간위술후（6.3±2.5）개월．좌측4례，우측2례．환자일기행환측경피신조루술（PCN술），이기행순행수뇨관연경하격광협착단내절개술，합병결석자일동처리결석．술전통과B초、CT、KUB+IVP、순행뇨로조영검사명학경조부위．협착단장도0.4～2.5 cm，평균0.9 cm．술후상규류치F6쌍J관12주．발제쌍J관후복사KUB+IVP．결과평균수술시간위（53±8） min，평균주원시간위（5.5±2） d，술중출혈량3～6 mL．수방시간위6～30개월，중위수방시간위18개월．5례균미견협착복발；1례재차출현협착，행순행수뇨관연경하화격광협착단내절개술，매12개월정기경환쌍J관．결론순행수뇨관연경하화격광내절개술처리Bricker술후수뇨관-장문합구협착안전、유효、수술병발증소．
Objective To evaluate the clinical efficacy and safety of application of anterograde flexible ureteroscope in the treatment of ureterointestinal anastomotic strictures in patients after Bricker urinary diversion. Methods From March 2009 to July 2012, 6 patients with ureterointestinal anastomotic strictures after Bricker procedure were enrolled in this study. The average age of the patients was (61 ±7) years old. The first clinical presentation was averagely (6.3 ±2.5) months after the Bricker procedure. There were 4 cases with left side strictures and 2 cases with right side ones. The urinary tract ultrasound, CT, KUB+IVP and antegrade urography were carried out to identify the obstructive portion. The mean length of stricture was 0.9cm (0.4~2.5) . First, all patients underwent percutaneous nephrostomy (PCN), then inside incision by Holmium:YAG laser under anterograde flexible ureteroscopy and lithotripsy (with calculi) . The F6 double J ureteral stent was indwelled for 12 weeks. KUB+IVP was performed after removal of double J ureteral stents. Results The mean operative time was (53±8) min. The mean hospital stay was (5.5±2) days. The blood loss was 3~6 mL. The average follow-up was 18 months (6~30) . No recurrence was found in 5 patients. One case had recurrent stricture after the first procedure, which was successfully managed by the flexible ureteroscopy again and replacing double J ureteral stent every 12 months. Conclusion The inside incision by anterograde flexible ureteroscopic Holmium:YAG laser is safe and effective for ureterointestinal anastomotic strictures in patients after Bricker urinary diversion, with less complications.