输尿管末端粘连:原位新膀胱术后上尿路积水原因之一

目的:总结原位新膀胱术后输尿管末端粘连致上尿路积水的诊断和处理经验。方法:2000年1月~2007年4月共施行全膀胱切除加原位新膀胱术250例,发现8例原位新膀胱术后患者上尿路积水是由输尿管末端互相粘连或与新膀胱壁粘连引起,在内镜下经尿道切断粘连带予以处理。结果:术后中位随访8个月(1~22个月),7例肾功能和积水程度明显改善,1例稳定,并在密切随访观察中。1例在积水缓解后7个月再次复发,发现输尿管肠吻合口狭窄,行开放手术作输尿管新膀胱再植,随访5个月,积水程度明显改善。结论:输尿管末端粘连是使用输尿管直接种植法的原位新膀胱术后上尿路积水的原因之一。膀胱镜检查既可明确诊断又能同时作粘连带切断而达到治疗的目的,因此,对原位新膀胱术后上尿路积水患者应常规作膀胱镜检查。

The conglutination of distal ureters: one of reasons of hydronephrosis after orthotopic neobladder reconstruction

Objective:To report the diagnosis and our experience of management of hydronephrosis caused by the conglutination of distal ureters after orthotopic neobladder reconstruction.Methods:From January 2000 to April 2007,we performed 250 cases of radical cystectomy and orthotopic neobladder reconstruction.We found 8 patients have hydronephrosis after orthotopic neobladder reconstruction due to the distal ureters conglutinating to each other or to the neobladder wall.We incised the conglutination band by a transurethral endoscope.Results:Postoperative median follow-up is 8 months(1 to 22 months).Seven cases had obvious improvement in renal function and hydronephrosis;one had stable renal function and hydronephrosis and was managed by observation.One patient was found hydronephrosis again after 7 months;and received open surgical revision due to ureteroenteric stenosis.The hydronephrosis have great improvement at 5-months' follow-up.Conclusions:The conglutination of distal ureters is one of reasons of hydronephrosis after orthotopic neobladder reconstruction using the technique of direct implantation.Cystoscopy can not only confirm diagnosis but also reach a treatment purpose by incising the conglutination band.Cystoscopy is mandatory in follow-up of patients who had hydronephrosis after orthotopic neobladder reconstruction.