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目的 总结全膀胱切除术后输尿管梗阻的诊断和微创处理方法。 方法 全膀胱切除术后输尿管梗阻患者 12例。原发病膀胱肿瘤 10例、结核性小膀胱 1例、放射性膀胱炎 1例。术后输尿管贮尿囊吻合口狭窄 9例、吻合口以上梗阻 3例。均采用MRI和肾镜下肾盂输尿管插管造影诊断。行手术治疗 11例 ,其中镍钛合金记忆金属网支架术 6例 ,输尿管支架术 4例 6侧 ,输尿管贮尿囊吻合术 1例。 结果 12例均诊断明确。 11例术后随访 3个月～ 5年。IVU示患肾功能恢复正常、肾积水消失 9例 ,肾积水减轻 2例。肌酐及尿素氮正常。 1例膀胱癌患者术后 6个月死于肿瘤肺转移。 结论 MRI和肾镜下的肾盂输尿管插管造影是最有价值的检查手段 ;输尿管支架术、输尿管镍钛记忆合金支架术手术简单、创伤小、效果好。
Objective To summarize the diagnosis and minimally invasive treatment of ureteral obstruction after total cystectomy. Methods 12 cases of ureteral obstruction after total cystectomy. Primary bladder tumor in 10 cases, tuberculous small bladder in 1 case, 1 case of radiation cystitis. Postoperative ureteral storage anastomotic stenosis in 9 cases, anastomotic obstruction in 3 cases. Both MRI and nephrolithotomy under ureteroscopy catheterization diagnosis. Surgical treatment of 11 cases, including nickel-titanium alloy memory metal stent in 6 cases, 4 cases of ureteral stenting in 6 cases, ureteral storage anastomosis in 1 case. Results 12 cases were diagnosed. Eleven cases were followed up for 3 months to 5 years. IVU showed renal function returned to normal, hydronephrosis disappeared in 9 cases, hydronephrosis reduced in 2 cases. Creatinine and urea nitrogen normal. One case of bladder cancer died of tumor lung metastasis 6 months after operation. Conclusion MRI and renal pelvis and ureteroscopic catheterization are the most valuable examination methods. Ureteral stenting and ureteral calcification titanium alloy stent are simple, less invasive and effective.