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目的评估腹腔镜下膀胱翻瓣成形治疗高位输尿管撕脱伤(输尿管撕脱长度>10cm)的临床疗效及安全性。方法回顾性分析2014年11月至2016年5月浙江省人民医院泌尿外科收治的输尿管撕脱伤患者4例,均于外院行输尿管镜碎石过程中发生输尿管高位撕脱,其中2例患者分别行输尿管造瘘、肾盂造瘘后转至我院,另外2例留置导尿管后直接转至我院;所有患者均采用腹腔镜下膀胱肌瓣替代缺损的输尿管进行治疗,术中采用带蒂大网膜覆盖吻合处,记录术中及术后并发症,并收集患者术后3~18个月的复查资料,包括肾功能、泌尿系B超或CT、分肾功能检查(ECT)。结果所有手术均一次顺利完成。平均手术用时104min,术中出血量平均为109mL。围手术期内无尿漏、肾绞痛、高热等并发症发生。在术后3~18个月的随访期内,患者的肾功能、肾盂分离程度均未发生明显变化。2例输尿管上段撕脱伤的患者术后3个月拔除双J管;另2例行输尿管或肾盂造瘘的患者均于术后3个月更换双J管,其中1例于术后6个月彻底拔除双J管。随访期内2例患者存在偶尔患侧腰酸、4例患者均无急性肾盂肾炎、肾积水加重、吻合口狭窄、肾萎缩发生。结论腹腔镜下膀胱翻瓣成形是治疗高位输尿管撕脱伤(输尿管撕脱长度>10cm)一种安全有效的治疗方法,具有创伤小、恢复快、并发症少等优点。
Objective To evaluate the clinical efficacy and safety of laparoscopic bladder flap in the treatment of upper ureteral avulsion (ureteral avulsion length> 10cm). Methods Retrospective analysis of 4 cases of ureteral avulsion injuries admitted to Department of Urology, Zhejiang Provincial People’s Hospital from November 2014 to May 2016, all of which occurred in high ureteroscopic avulsion in ureteroscopic lithotripsy in the outpatient department, of which 2 cases Line ureterostomy, renal pelvis fistula transferred to our hospital, the other two indwelling catheter directly to our hospital; all patients with laparoscopic bladder muscle flap instead of defect ureter for treatment, surgery using pedicle Omental coverage anastomosis, intraoperative and postoperative complications were recorded and the patients were reviewed after 3 to 18 months of data, including renal function, urinary tract ultrasound or CT, renal function test (ECT). Results All operations were completed successfully. The average operative time 104min, intraoperative bleeding average 109mL. Perioperative no urine leakage, renal colic, fever and other complications. During the follow-up period of 3 to 18 months after operation, no significant changes were found in renal function and pelvic separation. Two patients with upper ureteral avulsion were removed double J tube at 3 months after operation. Two patients undergoing ureteral or pyelo-pyrostomy were replaced with double J tube at 3 months after surgery, of which 1 was postoperative 6 Month completely remove the double J tube. During the follow-up period, 2 patients had occasional ipsilateral lumbar acidosis. None of the 4 patients had acute pyelonephritis, hydronephrosis increased, anastomotic stenosis and renal atrophy occurred. Conclusions Laparoscopic flap formation is a safe and effective treatment for upper ureteral avulsion (ureteral avulsion length> 10cm), with the advantages of less trauma, faster recovery and less complications.