输尿管下端狭窄诊治体会.docVIP

输尿管下端狭窄诊治体会【摘要】目的:探讨输尿管下端狭窄的诊治方法。 方法:回顾性分析13 例输尿管膀胱连接部狭窄的临床资料。男5例，女8例。平均年龄45 岁。左侧4 例，右侧7例，双侧2例。膀胱壁间段狭窄11例；膀胱前段狭窄2例，膀胱隧道式输尿管膀胱吻合术，术中留置双J 管10例，输尿管膀胱角吻合术2例，膀胱瓣输尿管下端成形术，术中留置双J 管1例。 结果:13例术后随访2 个月～6 年，全组无输尿管狭窄，治愈率69%，无效率31%。其中膀胱隧道式输尿管膀胱吻合术70%（7/10），好转率30%（3/10）；输尿管膀胱角吻合术50%（1/2），好转率50%（1/2）；膀胱瓣输尿管下端成形术治愈率100%（1/1）。膀胱造影无膀胱输尿管返流。 结论 膀胱隧道式输尿管膀胱吻合术和输尿管膀胱角吻合术治疗输尿管膀胱连接部狭窄创伤小，疗效满意。 【关键词】输尿管下端；狭窄；诊治 【中图分类号】R699【文献标识码】B【文章编号】1008-6455（2011）04-0334-02 【Abstract】Objective:TO explore the diagnosis and treatment for ureter distal part stricture. Methods:13 cases of ureter distal part stricture were analysed retrospectively，of them（man 5，women 8；average age 45） unilateral stricture of ureter distal part in 11（left 4，right 7）and bilateral stricture of ureter distal part in 2；of them the section of the wall of the bladder stricture in 11 and the anterior bladder stricture in 2. Bladder tunnel ureterovesical anastomosis and placing a double-J stent under endoscopy were performed in 10 cases, Ureterovesical-angle anastomosis were performed in 2 cases, bladder flap ureter distal part plasty and placing a double-J stent were performed in 1 case. Results:All cases were followed up 2 months to 6 years and cure rate 69%, the rate of iinvalidity was 31%. 70% of cure rate was achieved by bladder tunnel ureterovesical anastomosis; 50% of cure rate was achieved by ureterovesical-angle anastomosis; 100% of cure rate was achieved by bladder flap ureter distal part plasty. The renal function，hydronephrosis were obviously improved after operation and there was no vesicoureteral reflux. Conclusions:Bladder tunnel ureterovesical and ureterovesical-angle anastomosis are the safe and effective methods. 【Key words】ureter distal part；stricture；diagnosis and treatment 输尿管膀胱连接部狭窄病症隐匿，多数病情发展到一定程度以后才来院就诊。2005 年8 月至2010 年4月我们收治13 例，总结报告如下。 1 材料与方法 1.1 临床资料:本组13 例。男5例，女8 例。年龄15 岁～ 65岁，平均43 岁。左侧4 例，右侧7例，双侧2 例。膀胱壁间段狭窄9例；膀胱内段狭窄2例，膀胱前段狭窄2例。病程2 个月～ 6 年。临床表现腰痛8 例，其中持续性钝痛和隐痛6 例，伴阵发性加重2 例；尿频伴进行性排尿困难