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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 313 -316. doi: 10.3877/cma.j.issn.1674-3253.2021.04.010

临床研究

良性输尿管狭窄的治疗：90例单中心回顾分析
陈松1, 唐宇哲2, 付猛2, 苏博兴2, 刘宇保2, 肖博2, 胡卫国2, 李建兴2,†()   
  1. 1. 100072，北京市丰台中西医结合医院泌尿外科；102218　北京，清华大学附属北京清华长庚医院，清华大学临床医学院
    2. 102218　北京，清华大学附属北京清华长庚医院，清华大学临床医学院
  • 收稿日期:2020-12-08 出版日期:2021-08-01
  • 通信作者: 李建兴

Treatment of benign ureteral stenosis: retrospective analysis of 90 cases in single-center

Song Chen1, Yuzhe Tang2, Meng Fu2, Boxing Su2, Yubao Liu2, Bo Xiao2, Weiguo Hu2, Jianxing Li2,†()   

  1. 1. Department of Urology, Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing 100072, China; Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
    2. Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Received:2020-12-08 Published:2021-08-01
  • Corresponding author: Jianxing Li
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引用本文：

陈松, 唐宇哲, 付猛, 苏博兴, 刘宇保, 肖博, 胡卫国, 李建兴. 良性输尿管狭窄的治疗：90例单中心回顾分析[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 313-316.

Song Chen, Yuzhe Tang, Meng Fu, Boxing Su, Yubao Liu, Bo Xiao, Weiguo Hu, Jianxing Li. Treatment of benign ureteral stenosis: retrospective analysis of 90 cases in single-center[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(04): 313-316.

目的

回顾分析良性输尿管狭窄的病因及治疗效果。

方法

分析清华长庚医院2014年12月至2018年2月收治的良性输尿管狭窄病例资料。狭窄段病变根据长度（单位：cm）不同分为A （χ≤1）、B（1<χ≤2）、C（χ>2）3组。所有患者均行内镜手术治疗或开放/腹腔镜狭窄段切除再吻合等尿路重建成形手术。

结果

狭窄病变总共治疗117侧，其中86侧行内镜治疗，总体有效率为45.3%；31侧行开放/腹腔镜输尿管成形术，有效率为80.6%，明显高于内镜手术（P=0.01）。A、B、C三组内镜治疗的有效率分别为51.3%、44.1%、30.8%，差异无统计学意义（P=0.43）。

结论

开放/腹腔镜输尿管成形术治疗良性输尿管狭窄的有效率明显高于内镜手术。选择合适的病例，内镜手术可作为良性输尿管狭窄治疗的首选方案。即使内镜治疗失败，二期开放/腹腔镜输尿管成形术仍可取得满意的效果。

关键词: 输尿管狭窄, 球囊扩张, 腹腔镜, 内镜
Objective

To retrospectively analyze the etiology and treatment effects of ureteral stenosis.

Methods

The clinical data of patients with benign ureteral strictures admitted to Beijing Tsinghua Changgung Hospital from December 2014 to February 2018. Patients were divided into 3 groups according to the length of stenotic lesions (unit: centimeter): group A (χ≤1), group B (1<χ≤2) and group C (χ>2). All patients underwent endoscopic surgery or open/laparoscopic resection of stenosis site and re-anastomosis and other urinary tract reconstruction operations.

Results

There were 117 sides of stenosis treated. The methods were endoscopy and open/laparoscopic ureteroplasty. The effective rate of endoscopic treatment was 45.3% and 80.6% for open/laparoscopic ureteroplasty. The effective rate of open/laparoscopic surgery is higher than that of the endoscopic treatment (P=0.01). The effective rate in group A, B and C was 51.3%,44.1% and 63.3% respectively and there was no significant difference among them (P=0.43).

Conclusions

Open/laparoscopic ureteroplasty is more effective than endoscopic treatment of benign ureteral stenosis. For some proper cases of ureteral stricture, endoscopic surgery can be the first choice of treatment. Even if the endoscopic surgery fails, open/laparoscopic ureteroplasty can still be performed in the second stage, and the treatment effect is satisfactory.

Key words: Ureteral stenosis, Balloon dilatation, Laparoscopy, Endoscopy
表1 90例输尿管狭窄患者原因
病因 例数 百分率(%)
肾盂输尿管连接部梗阻 26 28.9
  未治疗 7  
  肾盂输尿管成形术后失败 19  
结石相关性 53 58.9
医源（非结石）性狭窄 7 7.8
  输尿管膀胱再植术后 2  
  输尿管吻合术后 1  
  经尿道电切损伤输尿管口 1  
  结肠术后 1  
  剖宫产术后 1  
  子宫切除术后 1  
原发性输尿管狭窄 2 2.2
输尿管外伤 1  
子宫内膜异位症 1  
表2 狭窄的部位和长度
狭窄情况 段数 百分率
部位    
  肾盂输尿管连接部 53 45.3%
  上段 32 27.4%
  中段 13 11.1%
  下段 19 16.2%
长度（cm）    
  χ≤1 48 41.0%
  1<χ≤2 50 42.7%
  χ>2 19 16.2%
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