改良腹腔镜膀胱腰大肌悬吊输尿管再植术治疗医源性长段输尿管狭窄

doi:10.3877/cma.j.issn.1674-3253.2023.02.014

目的

探讨改良腹腔镜膀胱腰大肌悬吊输尿管再植术治疗医源性长段输尿管下段狭窄的安全性及有效性。

方法

回顾性分析2017年1月至2020年5月在山西医科大学第二医院和上海交通大学附属第六医院泌尿外科行腹腔镜膀胱腰大肌悬吊输尿管膀胱再植术治疗医源性输尿管狭窄患者21例。患者年龄22~68岁，平均年龄（44±9）岁；左侧输尿管狭窄10例，右侧输尿管狭窄11例；术前6例行肾造瘘，15例长期留置双J管。输尿管狭窄长度为[8.6（7.9，10.0）]cm。本研究中对经典腰大肌悬吊输尿管膀胱再植术的改良主要包括：先将输尿管浆肌层与膀胱浆肌层缝合固定一针以减张和防扭曲；在4、6、8点方向缝合3针将输尿管和膀胱黏膜吻合后置入双J管；在12点方向输尿管和膀胱全层缝合以减张，在2点、10点方向行黏膜对黏膜吻合；采用黏膜下隧道法间断缝合3针抗返流。

结果

手术均顺利完成，无中转开放。手术时间为[88（78，96）]min，手术失血量[37（25，46）]ml。术后盆腔引流量[37.5(15.0，50.0)]ml，术后住院时间[5（4，6）]d，术后4周拔除双J管。术后随访13~40个月，静脉肾盂造影显示18例患者患侧肾盂积水、输尿管扩张均较术前明显缓解；轻度肾积水3例，膀胱造影提示1例患者轻度膀胱输尿管返流。

结论

改良腹腔镜膀胱腰大肌悬吊输尿管膀胱再植术治疗长段输尿管下段医源性狭窄病变安全、有效。

关键词: 腹腔镜, 悬吊术, 医源性，输尿管狭窄, 输尿管再植, 腰大肌综合征

Objective

To investigate the safety and effectiveness of modified laparoscopic urethral reimplantation with psoas hitch in the treatment of long iatrogenic urethral stricture.

Methods

The data of 21 patients with iatrogenic ureteral stricture treatment in the line laparoscopic bladder muscle suspension urethra bladder reimplantation treatment from January 2017 to May 2020 were analyzed retrospectively. The age of patients was ranged from 22 to 68 years, with an average of (44±9) years, the left ureteral stricture was in 10 cases, the right ureteral stricture 11 cases. Six cases underwent routine renal fistula, 15 cases long-term retention of double J tubes. The median length of ureteral stricture was [8.6(7.9, 10.0)] cm. In this study, the modified psoas hitch mainly includes: the urethra and bladder stitching fixed a needle to reduce the sheet and anti-distortion and using the mucous membrane tunnel method intermittent stitching 3 needles anti-reflux.

Results

All the operations were successfully completed by laparoscopy without open conversion. The median operative time was [88(78, 96)] min, and the estimated blood loss was [37(25, 46)] ml. The median pelvic drainage was [37.5(15.0, 50.0)] ml, the median postoperative hospital stay was [5(4, 6)] days, and double J tubes were removed 4 weeks after operations. The patients were followed up for 13-40 months. Postoperative follow-up IVU shows that 18 patients with hydronephrosis and ureteral dilatation were significantly relieved compared with those before operations, 3 patients with mild hydronephrosis, and cystography showed 1 patient with mild vesicoureteral reflus.

Conclusion

It is safe and effective using modified laparoscopic ureter reimplantation with bladder psoas hitch in the treatment of Iatrogenic ureteral stricture with long and lower segments.

Key words: Laparoscopy, Bladder psoas hitch, Iatrogenic, ureteral stricture, Ureteral reimplantation, Psoas major syndrome

图6 术后静脉肾盂造影提示膀胱腰大肌悬吊术后改变，左肾积水消失

[1]	Blackwell RH , Kirshenbaum EJ , Shah AS , et al. Complications of recognized and unrecognized iatrogenic ureteral injury at time of hysterectomy: a population based analysis[J]. J Urol, 2018, 199(6): 1540-1545.
[2]	赵翠翠, 李茂林. 微创技术在妇科手术并发输尿管损伤中的临床应用[J]. 国际泌尿系统杂志, 2021, 41(6): 1083-1085.
[3]	Smith W, Dutta R, Matthews C. Robotic-assisted ureteral reimplantation and psoas hitch after ureteral injury during cesarean section[J]. Int Urogynecol J, 2021, 32(10): 2867-2870.
[4]	蔡龙俊, 蔡维奇, 张绍崎,等. 腹腔镜下膀胱腰大肌悬吊法处理输尿管中长段损伤的初步研究[J]. 国际泌尿系统杂志, 2020, 40(1): 53-56.
[5]	Tyritzis SI, Wiklund NP. Ureteral strictures revisited trying to see the light at the end of the tunnel: a comprehensive review[J]. J Endourol, 2015, 29(2): 124-136.
[6]	Elawdy MM, Osman Y, Awad B, et al. Iatrogenic ureteral injuries: a case series analysis with an emphasis on the predictors of late ureteral strictures and unfavorable outcome in different surgical specialties[J]. Int Urogynecol J, 2021, 32(11): 3031-3036.
[7]	徐向军, 黄永斌, 刘兆飞，等. 医源性腔镜下输尿管损伤的原因分析与处理[J]. 中国微创外科杂志,2019, 19(4): 372-374.
[8]	Petersen SS, Doe S, Rubinfeld I, et al. Rate of urologic injury with robotic hysterectomy[J]. J Minim Invasive Gynecol, 2018, 25(5): 867-871.
[9]	袁耀基, 苏郑明, 梁健,等. 泌尿外科中输尿管狭窄的医源性危险因素及预防[J/OL]. 中华腔镜泌尿外科杂志（电子版）, 2017, 11(6): 423-425.
[10]	王毅, 于德新. 医源性输尿管损伤和继发狭窄的治疗进展[J]. 临床泌尿外科杂志, 2020, 35(9): 752-757.
[11]	Carbonara U, Branche B, Cisu T, et al. Robot-assisted ureteral reimplantation: a single-center comparative study[J]. J Endourol, 2021, 35(10): 1504-1511.
[12]	陈华, 刘泰荣, 宋乐明, 等. 腹腔镜手术治疗钬激光碎石术后输尿管狭窄的疗效观察[J]. 中华泌尿外科杂志, 2018(3): 218-221.
[13]	熊盛炜, 杨昆霖, 丁光璞, 等. 输尿管损伤外科修复治疗的研究进展[J]. 北京大学学报：医学版, 2019, 51(4): 783-788.
[14]	Nakamura S, Hyuga T, Tanabe K, et al. Long-term safety and efficacy of psoas bladder hitch in infants aged <12 months with unilateral obstructive megaureter[J]. BJU Int, 2020, 125(4): 602-609.
[15]	Paolo DO, Erika P, Pawel W, et al. Robot-assisted Boari flap and psoas hitch ureteric reimplantation: technique insight and outcomes of a case series with ≥1 year of follow-up[J]. BJU Int, 2021, 128(5): 625-633.
[16]	Federico A, Gallotta V, Foschi N, et al. Surgical outcomes of segmental ureteral resection with ureteroneocystostomy after major gynecologic surgery[J]. Eur J Surg Oncol, 2020, 46(7): 1366-1372.
[17]	Francesca M, Andrea M, Girolamo F, et al. Ureteral reimplantation with psoas bladder hitch in adults: a contemporary series with long-term followup[J]. Scientific World J, 2012, 2012:379316.
[18]	Ficarra V, Rossanese M, Crestani A , et al. A Contemporary Case Series of Complex Surgical Repair of Surgical/Endoscopic Injuries to the Abdominal Ureter.[J]. Eur Urol Focus, 2021, 7(6): 1476-1484.
[19]	Li Y, Li C, Yang S, et a1. Reconstructing full-length ureteral defects using a spiral bladder muscle flap with vascular pedicles[J]. Urology, 2014, 83(5): 1199-1204.
[20]	李万强, 廖正泉, 姚玲, 等. 腹腔镜Boari膀胱瓣替代术治疗宁长段输尿管撕脱[J]. 巴楚医学, 2022, 5(4): 4-6.
[21]	Andrew JK, Angela MA. Evolving surgical management of pediatric vesicoureteral reflux: is open ureteral reimplantation still the 'Gold Standard'?[J]. Int Braz J Urol, 2020, 46(3): 314-321.
[22]	Atar A, Eksi M, Güler AF, et al. Long term outcomes of laparoscopic and open modified lich-gregoir reimplantation in adults: a multicentric comparative study[J]. Pak J Med Sci, 2017, 33(4):788-792.
[23]	唐启胜, 马建军, 李瑞晓, 等. 腹腔镜下乳头式输尿管膀胱再植术技术改良探讨[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(6): 53-56.
[24]	吴振起, 巩会杰, 时京, 等. 腹腔镜黏膜下隧道法联合腰大肌悬吊输尿管膀胱再植术(附22例报道)[J]. 微创泌尿外科杂志, 2020, 9(1): 35-38.
[25]	Ding GP, Cheng SD, Li XF, et a1. Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures. [J]. Transl Androl Urol, 2021, 10(1): 56-65.

[1]	李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2]	李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3]	李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4]	陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5]	许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6]	李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7]	任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8]	赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9]	李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[10]	王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11]	杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12]	叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13]	郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14]	李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15]	魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Modified laparoscopic ureteral reimplantation with bladder psoas hitch in the treatment of iatrogenic ureteral stricture

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Modified laparoscopic ureteral reimplantation with bladder psoas hitch in the treatment of iatrogenic ureteral stricture