腔内技术处理膀胱全切术后输尿管肠吻合口梗阻

目的报道腔内技术处理膀胱全切术后输尿管肠吻合口梗阻的经验。方法 2001年6月至2008年5月对11例膀胱全切术后14侧输尿管肠吻合口梗阻采用腔内技术处理,顺行置入导丝通过梗阻后结合气囊扩张或内切开,并留置双J管6～8周。术后定期随诊,行B超、肾图和肾功能的检查。结果所有患侧输尿管均顺行成功将导丝通过梗阻段,3侧输尿管行气囊扩张,9侧输尿管行内切开,2侧输尿管怀疑肿瘤复发而直接置管。术后平均随访36.0（3～108）月,6侧输尿管拔除内支架管后引流通畅,肾图示尿路无明显梗阻。6侧输尿管在拔除内支架管后梗阻复发,分别采用永久肾造瘘（1侧）、输尿管换管（2侧）和开放手术处理（3侧）。术中术后均未见并发症发生。结论腔内技术处理输尿管肠吻合口梗阻简单安全,创伤小,可作为膀胱全切术后输尿管肠膀胱吻合口梗阻的首选治疗手段。

Endourological techniques for obstruction of ureterointestinal anastomosis after radical cystectomy

Objective To report our experience of endourological techniques for obstruction of ureterointestinal anastomosis after radical cystectomy.Methods During June 2001 and May 2008,11 patients with 14 ureterointestinal anastomotic obstructions after radical cystectomy were treated with antegrade percutaneous guidewire placement combined with balloon dilation or endoscopic incision.After the obstruction was dilated or completely cut,double-J stents were placed in the ureter for 6~8 weeks.During the follow-up,renal function,ultrasound examination and wash-out renal scintigraphy were performed every month for the first 6 months,and then every 3 months.Results In all patients the guidewire penetrated the obstruction.3 cases received balloon dilation,9 endoscopic incision,and 2 ureteral stent placement.During the follow-up of 36 months(3-108m),6 ureters remained patent and renal scintigraphy showed no obstruction.6 urteres had recurred obstruction,1 of which then received permanent nephrostomy,2 permanent change of ureteral cathers,and 3 open surgery.No complication was noted.Conclusions It is safe and minimal invasive to treat obstruction of ureterointestinal anastomosis after radical cystectomy with endourological techniques,which can be a first line therapy.