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[目的]探讨输尿管镜手术致输尿管严重损伤的治疗方法。[方法]报告5例因输尿管镜手术致输尿管严重损伤患者的临床治疗资料,结合文献复习讨论输尿管严重损伤的治疗方法。[结果]5例患者中,2例行输尿管-输尿管吻合术,1例行Boari氏膀胱瓣成型吻合术,1例行肾切除术,1例行回肠代输尿管术。术后随访8～42个月。4例(1例行患肾切除)患者患肾功能恢复良好,1例患者患侧肾脏输尿管有轻度积水,4例患者患侧肾脏输尿管排泄通畅。1例患者高氯性酸中毒,口服补碱后恢复正常。[结论]输尿管镜手术致输尿管严重损伤如患者情况允许可改开放手术行输尿管-输尿管吻合术、Boari氏膀胱瓣成型吻合术、肠道代输尿管术或自体肾移植术等,手术效果好。
[Objective] To discuss the treatment of severe ureteral injury caused by ureteroscopic surgery. [Method] The clinical data of 5 patients with severe ureteral injury due to ureteroscopic surgery were reported, and the literature reviewed the treatment of severe ureteral injury. [Results] Among the 5 patients, ureter-ureter anastomosis was performed in 2 cases, Boari’s bladder flap anastomosis in 1 case, nephrectomy in 1 case and ileal ureter in 1 case. The patients were followed up for 8 ~ 42 months. Four patients (1 patient undergoing nephrectomy) had a good recovery of renal function, 1 patient had mild hydronephrosis of the ureter in the ipsilateral kidney and 4 patients had ureter excretion unobstructed in the ipsilateral kidney. One patient had hyperchloric acidosis and returned to normal after oral administration of alkali. [Conclusions] Ureteroscopic urethral surgery caused serious damage to the ureter if urethral ureter, urethral anastomosis, Boari ’s anastomosis of bladder flap, intestinal transurethral ureter or autologous kidney transplantation can be changed. The operative effect is good.