输尿管末端粘连：原位新膀胱术后上尿路积水原因之一.pdfVIP

· 892 · Journal Of(linical Urology．Dec 2007．Vol 22．No 1 2 输尿管末端粘连：原位新膀胱术后 上尿路积水原因之一 侯国良 周芳坚 刘卓炜 秦自科 韩辉 余绍龙 李永红 陈晓峰 [摘要] 目的：总结原位新膀胱术后输尿管末端粘连致上尿路积水的诊断和处理经验。方法：2000年 1月 ～ 2007年4月共施行全膀胱切除加原位新膀胱术250例，发现8例原位新膀胱术后患者上尿路积水是由输尿管 末端互相粘连或与新膀胱壁粘连引起，在内镜下经尿道切断粘连带予以处理。结果：术后中位随访8个月(1～22 个月)，7例肾功能和积水程度明显改善，1例稳定，并在密切随访观察中。1例在积水缓解后7个月再次复发，发 现输尿管肠吻合口狭窄，行开放手术作输尿管新膀胱再植，随访5个月，积水程度明显改善。结论：输尿管末端粘 连是使用输尿管直接种植法的原位新膀胱术后上尿路积水的原因之一。膀胱镜检查既可明确诊断又能同时作粘 连带切断而达到治疗的目的，因此，对原位新膀胱术后上尿路积水患者应常规作膀胱镜检查。 [关键词] 输尿管粘连；原位新膀胱术；直接种植法；上尿路积水 [中图分类号] R693 [文献标识码] A [文章编号] 1001—1420(2007)12—0892—03 The c0nglutinati0n 0f distal ureters：one of reasons 0f hydr0nephr0sis after orthotopic neobladder rec0nstructi0n HOU Guoliang、 ZHoU Fangj ian、 LlU Zhuowei QlN Zikel HAN Hui yU Shaolong L Yonghong CHEN Xiao ng ( Department of Urology，Cancer Center，Sun Yat—Sen University；State Key Laboratory of On— cology in South China，Guangzhou，5 1 0060，China) Abstract 0bjective：To report the diagnosis and our experience of management of hydronephrosis caused by the conglutination of distal ureters after orthotopic neobladder reconstruction．Methods：From January 2000 tO A— pril 2007．we performed 250 cases of radical cystectomy and orthotopic neobladder reconstruction．We found 8 pa— tients have hydronephrosis after orthotopic neobladder reconstruction due tO the distal ureters conglutinatlng tO each other or to the neobladder wal1．We incised the conglutination band by a transurethral endoscope．Results： Postoperative median follow—uD is 8 months(1 tO 22 months)．Seven cases had obvious improvement in renal func- tion and hydronephrosis；one had stable renal function and hydronephrosis and was managed by observation． One