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目的:对照研究输尿管膀胱瓣吻合术和输尿管膀胱角吻合术的优缺点。方法:通过建立离体输尿管膀胱吻合术式模型,研究两种术式术前、术后膀胱容量及膀胱容量-压力的变化情况;并回顾性分析同一时期两种手术患者的临床情况,比较两种手术的优缺点。结果:输尿管膀胱瓣吻合术模型中,膀胱瓣同侧输尿管膀胱壁内段至膀胱瓣末端距离为16 cm;输尿管膀胱角吻合术模型中,同侧输尿管膀胱壁内段至丝线标记距离为12 cm。随着膀胱容量的不断增加,输尿管膀胱瓣吻合术模型中膀胱压的增加明显大于输尿管膀胱角吻合术模型中膀胱压的增加。临床随访中发现输尿管膀胱瓣手术组患者术后尿瘘、尿频、尿急等发生率明显高于输尿管膀胱角吻合术组。结论:两种手术在安全性方面没有区别。当临床输尿管下段缺损长度在10 cm以内,可采取输尿管膀胱角手术;当临床输尿管中下段缺损长度在10～14 cm时,可采取输尿管膀胱瓣吻合术;肾移植术后患者不宜采用输尿管膀胱瓣吻合术。
Objective: To compare the advantages and disadvantages of ureterovascular anastomosis and ureterovascular anastomosis. Methods: The model of anastomosis of ureteric bladder anastomosis was established to study the changes of bladder volume and bladder volume-pressure before and after the operation of two kinds of surgery. The clinical situation of the two surgical patients in the same period was retrospectively analyzed. The advantages and disadvantages of surgery. Results: In the model of anastomosis of the ureteric bladder flap, the distance between the bladder wall and the bladder flap was 16 cm. The ureteral bladder anastomosis model had a 12 cm . With the increase of bladder volume, the increase of bladder pressure in ureteric bladder flap anastomosis model was obviously greater than that of ureteral bladder anastomosis model. Clinical follow-up found that the incidence of urinary fistula, urinary frequency, urinary urgency and other postoperative urinary bladder flap surgery group was significantly higher than ureteral bladder anastomosis group. Conclusion: There is no difference in safety between the two procedures. When the length of clinical lower ureteral defect less than 10 cm, can take the ureter of bladder surgery; when the length of the lower ureter in the lower end of the 10 ~ 14 cm, ureteral bladder flap anastomosis can be taken; kidney transplant patients should not use the bladder valve Anastomosis.