腹腔镜膀胱肌瓣输尿管成形术处理输尿管淀粉样变1例报告

1 临床资料 患者,女,71岁,因"间断性无痛性血尿4年,加重3周"入院.2015年10月无明显诱因出现无痛性全程血尿,无下尿路刺激症状,无腰痛及发热.予抗生素治疗后血尿消失,但仍有反复.尿脱落细胞学和抗酸杆菌检查均为阴性.肾动静脉增强CT检查(图1a)提示:右侧肾盂肾盏、右输尿管中上段轻度积水扩张,输尿管管壁增厚,以...     

膀胱肌瓣输尿管成型术治疗输尿管中下段长段损伤17例报告

目的探讨膀胱瓣输尿管成形术治疗输尿管中下段长段病变的疗效。方法采用膀胱肌瓣输尿管吻合术治疗输尿管中下段长段狭窄或缺损17例,16例为医源性损伤,其中8例为妇产科手术、3例为普外科手术、2例为腔内泌尿外科手术、2例为输尿管下段开放取石术后、1例为输尿管吻合术后吻合口断裂;另外1例为先天性巨输尿管症。所有患者行膀胱肌瓣输尿管成形术。结果所有患者均吻合成功,13例患者术后随访3月～1年,全部尿路梗阻消除,未发生新的再狭窄,1例重度膀胱输尿管返流。结论膀胱肌瓣输尿管成形术治疗输尿管中下段长段损伤效果较满意。     

螺旋状带蒂膀胱肌瓣输尿管成形术修复全程输尿管损伤的疗效分析(附6例报告)

目的:观察螺旋状带蒂膀胱肌瓣输尿管成形术修复全程或接近全程输尿管损伤的疗效,探讨膀胱肌瓣修复长段输尿管损伤(20cm)的手术方式。方法:回顾性分析6例因输尿管上段结石行输尿管镜下碎石术并发的全程或接近全程输尿管损伤患者的治疗过程:男4例,女2例;年龄37~59岁,平均49岁;左侧4例,右侧2例。其中输尿管黏膜全程撕脱2例,自肾盂至膀胱连接处输尿管完全离断4例;损伤长度21~25cm,平均22cm。6例均采用螺旋状带蒂膀胱肌瓣输尿管成形术。术中注意保护患侧膀胱上动脉的完整性,取瓣要循膀胱上动脉走行裁剪。其中5例术中同行肾脏下降固定术和膀胱腰大肌悬吊术,以缩短患侧肾和膀胱间距,1例切瓣卷管后直接与肾盂端吻合。酌情转移带蒂大网膜组织覆盖重建输尿管。结果:6例手术顺利,手术时间1~2h,平均1.5h。5例成形输尿管旁引流管术后第3天拔除,1例因漏尿于术后第10天拔除。6例切口均一期愈合。术后2周复查血肌酐和尿素氮正常,术后8周在膀胱镜下安全拔除双J管。1例术中未同行肾脏下降固定术和膀胱腰大肌悬吊术的患者术后3个月行静脉尿路造影(IVU)检查,发现重建输尿管明显狭窄且伴肾积水,重新置入双J管行保守治疗,2个月后复查ECT示患侧肾脏功能重度受损,于术后6个月行患肾切除术。1例术后6个月IVU复查时发现手术侧轻度肾积水及输尿管轻度扩张,但总肾功能正常。余4例随访2~4年,未见明显异常,IVU检查显示手术侧成形输尿管形态均正常,显影良好,均未发现明显的膀胱输尿管反流,因膀胱容量缩小导致的下尿路症状(LUTS)不明显。结论:螺旋状带蒂膀胱肌瓣输尿管成形术是长段输尿管损伤修复的理想术式,创伤小,并发症少,恢复快,尤其适用于缺损长度超过20cm乃至全程输尿管损伤的修复治疗,有较高的推广价值。     

螺旋状带蒂膀胱肌瓣修复长段输尿管缺损的疗效分析

目的 探讨螺旋状带蒂膀胱肌瓣输尿管成形术治疗长段( ＞20 cm)输尿管缺损的方法及疗效. 方法 回顾性分析采用螺旋状带蒂膀胱肌瓣输尿管成形术治疗5例肾盂输尿管连接处狭窄合并结石,行输尿管镜下碎石术操作过程中因套篮取石或碎石后退镜等发生的长段输尿管缺损患者的临床疗效.5例患者中男3例,女2例;年龄37 ～59岁,平均48岁;左侧4例,右侧1例.其中输尿管黏膜全程撕脱2例,自肾盂至膀胱连接处输尿管完全离断3例;缺损长度21～25 cm,平均22cm.5例均急诊行螺旋状带蒂膀胱肌瓣输尿管成形术,同时行患侧膀胱腰大肌固定,成形输尿管内置7F双J管,新建输尿管平均长度22 cm. 结果 5例手术顺利.手术时间1～2h,平均1.5h.术后成形输尿管旁引流管第3天拔除4例,1例因漏尿于术后第10天拔除.5例切口均一期愈合.术后2周复查血肌酐和尿素氮指标正常,术后8周在膀胱镜下安全拔除双J管.1例术后6个月复查时发现手术侧轻度肾积水及输尿管轻度扩张,但总肾功能正常;4例随访2～4年未见明显异常,IVU检查显示手术侧成形输尿管形态均正常,显影良好. 结论 螺旋状带蒂膀胱肌瓣输尿管成形术是长段输尿管损伤修复的理想术式,有较高的推广价值.     

膀胱粘膜肌瓣翻转术在抗膀胱输尿管返流术中的应用(附四例报告)

目的　提高治疗膀胱输尿管返流的手术疗效。　方法　采用膀胱粘膜肌瓣翻转抗返流术治疗膀胱输尿管返流 4例 ,其中因输尿管壁段结石行经尿道输尿管口切开致膀胱输尿管返流 2例 ,原发性膀胱输尿管返流 2例。Ⅲ°1例 ,Ⅳ°3例。　结果　术后 2例出现膀胱刺激症状及膀胱痉挛 ,1个月后症状明显改善 ,3个月后症状完全消失。 4例平均随访 2 2个月 ,患者症状消失 ;IVU示患侧肾功能良好 ,3例肾积水及输尿管扩张完全消失 ,1例改善 ;膀胱造影均未见膀胱输尿管返流 ;膀胱镜可见再造输尿管口呈唇状。　结论　膀胱粘膜肌瓣翻转抗返流术治疗膀胱输尿管返流简便、有效 ,但存在术后膀胱刺激症状重的缺点。     

膀胱瓣输尿管成形术治疗10例移植肾输尿管梗阻的经验分析

目的:探讨膀胱瓣输尿管成形术(boari flap ureteroplasty,BFU)治疗移植肾输尿管梗阻的效果和经验。方法:回顾性分析我院近5年来应用BFU治疗10例移植肾输尿管梗阻患者的临床资料及随访结果,观察移植肾输尿管是否再次发生梗阻和积水。结果:所有患者移植肾输尿管梗阻均得到完美重建,随访1～5年B超检查未见移植肾梗阻和积水,移植肾功能维持正常。结论:BFU是治疗肾移植术后输尿管长段梗阻的有效方法,且近、远期疗效满意。     

1例滑动疝手术致膀胱损伤患者的护理

对1例滑动疝手术过程中误伤膀胱,立即进行膀胱修补。术后加强病情观察,做好体位、管道护理,充分镇痛解痉及心理疏导等,患者于术后15d痊愈出院。术后个性化的全方位护理有利于患者康复。     

腹腔镜膀胱壁瓣法输尿管膀胱再植术

目的 探讨腹腔镜膀胱壁瓣法输尿管膀胱再植术的可行性和临床疗效。方法 采用经腹腔途径施行腹腔镜膀胱壁瓣法输尿管膀胱再植术治疗输尿管出口梗阻9例。左侧1例，右侧7例，双侧1例。4例为单纯性输尿管出口狭窄，1例输尿管出口狭窄伴对侧输尿管结石，1例输尿管出口狭窄者经尿道钬激光切开术后1年出现再次狭窄，1例为开放输尿管膀胱再植术后再发输尿管出口狭窄，1例为泌尿系结核左肾切除术后右侧输尿管出口狭窄，1例为右卵巢囊肿术后双侧输尿管出口梗阻伴发急性肾衰竭2周。B超和IVU检查示重度肾积水6例7侧，中度肾积水3例。结果 9例手术均顺利。手术耗时115～180min/侧，平均132min／侧。术中出血40～150ml，平均62ml。术后1～3d拔除膀胱外引流管下地活动，无一例漏尿。术后1周拔除导尿管，7—14d出院，平均住院时间8d。术后1个月拔除双J管。术后3～6个月膀胱造影显示I度双侧输尿管返流1例，无返流8例。随访3～16个月，B超和IVU、MRU复查无吻合口狭窄，肾积水均得到明显改善，中度肾积水者2例，轻度肾积水者4例，无明显肾积水者3例。结论 腹腔镜膀胱壁瓣法输尿管膀胱再植术手术效果好，抗返流效果佳，刨伤小，是治疗输尿管出口病变的微创新途径。     

中期妊娠引产致子宫破裂合并输尿管膀胱损伤1例

1 病例资料 患者女,31岁,因孕5个月引产及碎胎术后流产不全伴阴道大量流血,于2003年4月11日入院.患者曾于2年前行足月妊娠剖宫产术.入院前曾于4月7日外院行利凡诺引产术,于8日下午出现腹痛,至9日下午持续性腹痛加重,阴道流血较多,1 h后腹痛渐消失,但胎儿未排出,分别于10日16∶00及11日9∶00两次行碎胎术, 均未成功, 出血量多, 且第一次碎胎术后出现无尿.查体:T35.2℃,P120次/min,Bp 0 kPa,神志恍惚,贫血貌,下腹正中有一纵形陈旧性手术疤痕,板状腹,全腹压痛、反跳痛,未触及子宫轮廓及胎块.妇科检查:阴道仍有少量出血,阴道壁及宫颈无裂伤,宫口扩张3 cm, 内有大量血块堵塞, 未触及胎体.B超示: 子宫增大,宫腔内未见胎儿回声,于腹腔内可见一胎儿回声,双顶径5.35 cm,无胎心搏动,盆腔内可见不规则液性暗区,诊断为:流产不全,子宫破裂,失血性休克.立即在抗休克同时行剖腹探查术,术中见:子宫左侧有一残缺胎儿,仅有头颅、双上肢及胸廓,取出;     

带血管神经蒂肌瓣重建脊髓损伤后膀胱功能的研究进展

肌瓣带蒂转移或游离移植不仅可应用于创面缺损的覆盖、外形的重建，有收缩能力的肌瓣还被广泛应用于瘫痪肌肉的动力功能重建。除了骨科临床常用的四肢动力功能重建外，还被探索应用于外科其它领域的功能重建。如Acker报道的背阔肌心肌成形术(cardiomyoplasty)、Perez—Abadia等报道的股薄肌成形术(graciloplasty)以及Baeten等报道的动力性股薄肌成形术(dynamic graciloplasty)等，Stremel将其统称为动力性肌成形术(dynamic myoplasty)。脊髓损伤后膀胱功能障碍是截瘫患者晚期死亡的主要原因之一。     

游离皮瓣移植修复大面积缺损的术后护理

目的:观察游离皮瓣移植修复大面积缺损的术后护理效果。方法:选择接受游离皮瓣移植修复大面积缺损术后护理50例,手术后对患者实施系统的护理,包括术后的心理护理、一般护理、术后皮瓣的观察与护理及血管危象的判断及处理。结果:2例发生动脉危象,1例发生静脉危象,护士仔细观察、正确分析、报告医师后再次手术探查,重行血管吻合术、血管移植术,全部成活。结论:术后严密观察皮瓣血运、色泽、温度及肿胀程度,正确识别动、静脉危象并报告医生及时处理,以提高游离皮瓣移植的成功率。     

Vaginal flap urethral reconstruction: an alternative to the bladder flap neourethra

Vaginal flap urethral reconstruction was done in 10 women who sustained total or partial loss of the urethra, and extensive damage to the vesical neck and trigone due to operative complications. In all patients a neourethra was constructed by rolling a vaginal flap into a tube and covering the anastomosis with a labial pedicle fat pad graft and vaginal flap. Five patients underwent a concomitant pubovaginal sling procedure, 3 had a modified Pereyra operation and 1 had a modified Kelly plication. Postoperatively, 9 of the 10 patients had a satisfactory neourethra but 3 required a generous meatotomy to facilitate micturition. Two patients required temporary intermittent self-catheterization. Of the 10 patients 6 were completely continent after a single reconstruction, which included an anti-incontinence repair. Of the patients with postoperative incontinence 2 subsequently were cured with a pubovaginal sling and 1 had a vesicovaginal fistula that was successfully repaired transvaginally. These results support our contention that a vaginal flap urethral reconstruction combined with an appropriate anti-incontinence operation offers a viable and simple alternative to bladder flap urethral reconstruction.     

化学去细胞同种异体神经移植术后病人的护理

[目的]探讨对化学去细胞同种异体神经修复周围神经损伤的护理及康复。[方法]自2003年4月-2006年4月，应用化学去细胞同种异体神经移植治疗完全断裂周围神经损伤患者39例，术后及出院后进行专项护理及康复，术后6个月以上患者随访共21例，对结果进行统计分析。[结果]21例患者中，16例神经损伤恢复效果达到优良，修复优良率达到71．4％。[结论]对化学去细胞同种异体神经移植术后的患者进行康复及护理，可以获得良好的临床效果。     

Repair of a urethral fistula following electrical burns using a gracilis muscle flap

An unusual example of electrical burns of the genitalia resulting in a urethral fistula is reported because of its clinical rarity. Reconstruction was carried out using a unilateral gracilis muscle flap.     

Vaginal reconstruction using urinary bladder flap in a patient with cloacal malformation

We report a case of vaginal reconstruction using a flap from urinary bladder in a young girl. This girl was born with cloacal malformation and hemivaginas connected to the urinary bladder. Repeated urinary tract infection and vesicoureteral reflux were noted. At the age of 9 months, she received posterior sagittal anorectoplasty for rectum pull-through, but the urogenital part was not corrected. She had repeated urinary tract infection. Detrusor areflexia and large bladder volume were demonstrated by cystometry. Cystoscopy showed a common channel longer than 3 cm. Urogenital reconstruction was performed at 14 months of age. A part of the urinary bladder wall, which was connected to the vaginas, was used to lengthen the vagina so that the latter was able to pull down to the perineum. The patient received vaginal dilatation and intermittent catheterization after the surgery.     

Cancer of the bladder in a patient with spinal cord injury

A case of cancer of urinary bladder in a 39-year-old incomplete C7 paraplegic male is reported. He was injured in 1962, and was admitted to our department in August, 1982 because of macrohematuria. Intravenous pyelography showed dilation of right ureter and pelvis. Cystography revealed filling defect on the right wall of bladder, but vesicoureteral reflux was not seen. Endoscopically, we found the tumor on the right wall, which seemed to invade to the trigone and right ureteral orifice. CT scan and pelvic angiography showed that the tumor extended extramurally of the bladder and metastasized to lymph-nodes. In November, 1982, bilateral ureterocutaneostomy, and 30 days later, total cystectomy were performed. The removed bladder demonstrated transitional cell carcinoma with undifferentiated tumor cells. The patient died of recurrence of the tumor in the small pelvic cavity, 60 days later. Ten cases of bladder cancer in patients with spinal cord injury were collected from Japanese literature including ours, and the importance of periodic cytology, cystoscopy and random biopsy for early diagnosis of bladder cancer on paraplegics were discussed.     

Infection-induced urethral defect treated by urethral reconstruction with a radial forearm flap

Abstract A 47-year-old man was admitted with the chief complaint of a urethral defect. An approximately 17-cm defect of the urethra seemed to have been occurred by the infection of implanted foreign bodies in the penile skin. Reconstruction of the urethra and the ventral skin was performed with a free radial forearm flap. A fistula formed at the proximal anastomosis after the operation, but was controlled conservatively. Urethral stricture at the proximal anastomosis subsequently developed. A urethral stent made of shape memory alloy was placed with the preservation of voiding function.