口腔黏膜输尿管成形术与狭窄段切除吻合术治疗输尿管狭窄的疗效比较

doi:10.3877/cma.j.issn.1674-3253.2024.03.010

目的

比较口腔黏膜输尿管成形术与传统狭窄段切除吻合术治疗输尿管狭窄的效果。

方法

回顾性分析2019年7月至2022年7月安徽医科大学第二附属医院收治的40例输尿管狭窄患者的临床资料，根据手术方式分为观察组18例（腹腔镜下口腔黏膜输尿管成形术）与对照组22例（腹腔镜下输尿管狭窄段切除吻合术）。两组术后3个月及6个月通过影像学检查评估手术疗效。

结果

所有手术均顺利完成，无明显并发症。观察组手术时间（198±40）min，术中出血量40.0（40.0，50.0）ml高于对照组[（170±42）min和20.0（10.0，50.0）ml]（P<0.05）；术后两组肾积水程度均改善明显，观察组术后3个月、6个月肾盂分离度减少优于对照组，观察组治愈率66.67%、有效率94.44%，高于对照组54.55%和86.36%，但差异均无统计学意义（P>0.05）。

结论

两种手术方式治疗输尿管狭窄段长度为1.0～2.5 cm的病例均具有良好效果，口腔黏膜输尿管成形术由于术中吻合张力小，可能更适用于长段输尿管狭窄。

关键词: 输尿管狭窄, 医源性损伤, 口腔黏膜补片, 腹腔镜, 输尿管成形术

Objective

To compare the effect of oral mucosal ureteroplasty and traditional stricture resection and anastomosis in the treatment of ureteral stricture.

Methods

The clinical data of 40 patients with ureteral stricture admitted to the Second Affiliated Hospital of Anhui Medical University from July 2019 to July 2022 were retrospectively analyzed. According to the surgical methods, 18 patients were divided into the observation group (laparoscopic oral mucosal ureteroplasty) and 22 patients in the control group (laparoscopic resection and anastomosis of ureteral stricture). Both groups were evaluated by imaging examination at 3 and 6 months after operation.

Results

All operations were successfully completed without obvious complications. The surgical time [(198±40) min] and intraoperative bleeding volume [40.0(40.0, 50.0) ml] in the observation group were higher than those in the control group [(170±42) min and 20.0 (10.0, 50.0) ml] (P<0.05). The degree of hydronephrosis in both groups improved significantly after surgery. The separation of renal pelvis in the study group decreased 3 months and 6 months after surgery, which was better than that in the control group, the cure rate 66.67% and effective rate 94.44% of the observation group were higher than those of the control group (54.55% and 86.36%), but there were no significant difference between the two groups (P>0.05).

Conclusion

Both surgical methods have shown good results in treating cases with a narrow segment length of 1.0-2.5 cm. Oral mucosal ureteroplasty may be more suitable for long segment ureteral stenosis due to its low intraoperative anastomotic tension.

Key words: Ureteral sricture, Iatrogenic injury, Oral mucosa, Laparoscopy, Ureteroplasty

表1 两组输尿管狭窄患者一般资料比较

组别	例数	性别(例)		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	狭窄段长度[cm，M(Q)]	术前肾盂分离度[mm，M(Q)]	术前尿白细胞[×10⁹/L，M(Q)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	狭窄段长度[cm，M(Q)]	术前肾盂分离度[mm，M(Q)]	术前尿白细胞[×10⁹/L，M(Q)]
观察组	18	8	10	46±10	25±3	2.00(2.00，2.50)	35.9(31.1，41.1)	25.1(8.5，35.0)
对照组	22	15	7	46±18	24±4	2.00(1.50，2.13)	31.7(23.3，44.1)	15.2(8.9，22.6)
统计值		χ²=2.283		t=-0.071	t=-0.708	Z=-1.640	Z=-0.585	Z=-1.387
P值		0.131		0.944	0.483	0.101	0.559	0.166

表1 两组输尿管狭窄患者一般资料比较

组别	例数	性别(例)		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	狭窄段长度[cm，M(Q)]	术前肾盂分离度[mm，M(Q)]	术前尿白细胞[×10⁹/L，M(Q)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	狭窄段长度[cm，M(Q)]	术前肾盂分离度[mm，M(Q)]	术前尿白细胞[×10⁹/L，M(Q)]
观察组	18	8	10	46±10	25±3	2.00(2.00，2.50)	35.9(31.1，41.1)	25.1(8.5，35.0)
对照组	22	15	7	46±18	24±4	2.00(1.50，2.13)	31.7(23.3，44.1)	15.2(8.9，22.6)
统计值		χ²=2.283		t=-0.071	t=-0.708	Z=-1.640	Z=-0.585	Z=-1.387
P值		0.131		0.944	0.483	0.101	0.559	0.166

图1 腹腔镜下口腔黏膜输尿管成形术术中关键步骤注：a为游离出输尿管狭窄段；b为纵行切开狭窄段输尿管；c为修剪口腔黏膜；d为吻合口腔黏膜与输尿管黏膜

表2 两组输尿管狭窄患者围手术期资料比较

组别	例数	手术时间[min，(±s)]	术中出血量[ml，M(Q)]	术后留置导尿管时间[d，M(Q)]	术后留置引流管时间[d，M(Q)]
观察组	18	198±40	40.0(40.0，50.0)	6.0(4.8，8.0)	3.0(2.8，4.0)
对照组	22	170±42	20.0(10.0，50.0)	6.0(5.0，7.5)	3.0(2.0，3.3)
统计值		t=-2.140	Z=-2.812	Z=-0.291	Z=-1.334
P值		0.039	0.005	0.778	0.182

表2 两组输尿管狭窄患者围手术期资料比较

组别	例数	手术时间[min，(±s)]	术中出血量[ml，M(Q)]	术后留置导尿管时间[d，M(Q)]	术后留置引流管时间[d，M(Q)]
观察组	18	198±40	40.0(40.0，50.0)	6.0(4.8，8.0)	3.0(2.8，4.0)
对照组	22	170±42	20.0(10.0，50.0)	6.0(5.0，7.5)	3.0(2.0，3.3)
统计值		t=-2.140	Z=-2.812	Z=-0.291	Z=-1.334
P值		0.039	0.005	0.778	0.182

表3 两组输尿管狭窄患者术后疗效比较

组别	例数	术后肾盂分离度[mm，M(Q)]		术后肾盂分离度下降值[mm，M(Q)]		治愈率[例(%)]	缓解率[例(%)]	无效率[例(%)]	有效率[例(%)]
组别	例数	3个月	6个月	3个月	6个月	治愈率[例(%)]	缓解率[例(%)]	无效率[例(%)]	有效率[例(%)]
观察组	18	12.3(9.0，19.4)	10.2(8.0，15.4)	22.2(17.1，28.6)	25.3(17.0，30.3)	12(66.67)	5(27.77)	1(5.56)	17(94.44)
对照组	22	16.0(11.0，22.2)	11.8(8.2，18.8)	15.1(6.9，26.7)0	19.2(9.7，33.5)0	12(54.55)	7(31.81)	3(13.64)	19(86.36)
统计值		Z=-1.210	Z=-0.872	Z=-1.550	Z=-1.020	-	-	-	χ²=0.101
P值		0.226	0.383	0.121	0.308	-	-	-	0.751

表3 两组输尿管狭窄患者术后疗效比较

组别	例数	术后肾盂分离度[mm，M(Q)]		术后肾盂分离度下降值[mm，M(Q)]		治愈率[例(%)]	缓解率[例(%)]	无效率[例(%)]	有效率[例(%)]
组别	例数	3个月	6个月	3个月	6个月	治愈率[例(%)]	缓解率[例(%)]	无效率[例(%)]	有效率[例(%)]
观察组	18	12.3(9.0，19.4)	10.2(8.0，15.4)	22.2(17.1，28.6)	25.3(17.0，30.3)	12(66.67)	5(27.77)	1(5.56)	17(94.44)
对照组	22	16.0(11.0，22.2)	11.8(8.2，18.8)	15.1(6.9，26.7)0	19.2(9.7，33.5)0	12(54.55)	7(31.81)	3(13.64)	19(86.36)
统计值		Z=-1.210	Z=-0.872	Z=-1.550	Z=-1.020	-	-	-	χ²=0.101
P值		0.226	0.383	0.121	0.308	-	-	-	0.751

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Comparison of the therapeutic effect of oral mucosal ureteroplasty and narrow segment resection and anastomosis in the treatment of ureteral stricture

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Comparison of the therapeutic effect of oral mucosal ureteroplasty and narrow segment resection and anastomosis in the treatment of ureteral stricture