输尿管长段撕脱伤3例报道及防治分析

发布时间：2018-06-13 15:51

本文选题：输尿管长段撕脱伤 + 回肠代输尿管术　；参考：《泌尿外科杂志(电子版)》2017年01期

【摘要】：目的对3例输尿管长段撕脱的患者进行回顾性分析,旨在为输尿管长段撕脱伤的预防及治疗提供可参考的建议。方法收集2014年至2016年浙江大学医学院附属第一医院收治的输尿管长段撕脱患者的临床资料并进行回顾性分析。结果 1号患者行回肠代左输尿管术,术后1个月查IVU提示患侧显影正常,未见异常狭窄及尿外渗,B超提示患侧肾轻中度积水;术后3个月,拔除双J管时,CT检查提示左肾及输尿管上段积水。2号患者输尿管撕脱后8小时急诊行腹腔镜膀胱瓣成形输尿管吻合术,术后2个月复查B超提示右肾轻度积水;术后3个月患者无尿频症状,复查CT检查提示右肾轻度积水,复查IVU提示患侧显影正常,未见异常狭窄及尿外渗,行输尿管软镜探查术,术中可见输尿管全程通畅,无狭窄,原膀胱、输尿管吻合处伤口愈合佳、无狭窄。3号患者撕脱后1个月行腹腔镜膀胱瓣成形输尿管吻合术,术后3个月拔除双J管,术后3个月查IVU提示患侧显影正常,未见异常狭窄及尿外渗,CT检查提示患侧肾无积水。结论针对输尿管长段撕脱伤重在预防,在输尿管镜手术中术者应规范操作,切忌使用暴力。当输尿管长段撕脱伤已然发生时,早期行回肠代输尿管术或膀胱瓣成形输尿管吻合术都是良好的可选补救措施。
[Abstract]:Objective to retrospectively analyze 3 patients with long ureteral avulsion in order to provide reference for the prevention and treatment of long ureteral avulsion injury. Methods the clinical data of patients with long ureteral avulsion treated in the first affiliated Hospital of Zhejiang University Medical College from 2014 to 2016 were collected and analyzed retrospectively. Results one month after operation, IVU showed that the affected side had normal development, no abnormal stricture and extravasation, B ultrasound showed mild and moderate hydronephrosis in the affected side, 3 months after operation. Ct examination showed that left kidney and upper ureter were hydronephrosis 8 hours after ureteral avulsion and 2 months after operation, laparoscopic ureterostomy was performed in patients with ureteral avulsion. 2 months after operation, B ultrasound showed mild hydronephrosis in right kidney. Three months after operation, the patients had no symptoms of frequent urination. Ct examination showed mild hydronephrosis in the right kidney, and IVU showed that the affected side had normal development, no abnormal stricture and extravasation. The patients underwent soft ureteroscope exploration. The whole course of ureter was patency and no stenosis was found during the operation. The wound healed well in primary bladder and ureteral anastomosis without stenosis. Laparoscopic ureteroplasty with bladder flap was performed 1 month after avulsion, double J tube was removed 3 months after operation, IVU showed normal development 3 months after operation. No abnormal stenosis and extravasation of urine were found in CT examination. No hydronephrosis was found in the affected kidney. Conclusion for the prevention of long ureteral avulsion injury, the operation should be standardized and violence should be avoided. Early ileal ureteroplasty or ureterostomy with bladder flap is a good remedy when long ureteral avulsion injury has already occurred.
【作者单位】：浙江大学医学院附属第一医院泌尿外科;浙江省人民医院泌尿外科;
【分类号】：R699.4

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