膀胱全切原位回肠新膀胱术后输尿管肠吻合口良性狭窄的处理

目的：探讨膀胱全切原位回肠新膀胱术后输尿管肠吻合口良性狭窄的处理方法。方法：我科自2003年1月～2012年6月采用膀胱全切原位回肠新膀胱术治疗395例膀胱癌患者。术后发生输尿管肠吻合口良性狭窄10例，采用输尿管镜扩张、内镜下逆行／经皮穿刺顺行球囊扩张、内镜下狭窄段内切开、开放输尿管膀胱再植术，并留置双J管3～6个月。结果：本组10例中，1例（1处）因导丝不能通过狭窄段而改行开放手术，术后随访36个月，肾积水明显改善。其余9例（11处）采用腔内技术处理，其中3例（4处）采用输尿管镜扩张，2例（3处）采用内镜下狭窄段内切开，4例（4处）采用内镜下逆行／经皮穿刺顺行球囊扩张。术后随访9～72个月（中位25个月）。5例（7处）肾积水明显改善，2例（2处）肾积水长期随访无加重，2例（2处，狭窄段长分别为1．2cm、1．5cm）再发狭窄，遂采用开放手术，分别随访16及24个月，肾积水改善。结论：腔内技术操作简单，创伤小，可作为输尿管肠吻合口良性狭窄的首选治疗方案。开放手术仍然是治疗输尿管肠吻合口狭窄的金标准。对于狭窄段〉1cm的患者，应首先考虑开放手术。

Management of benign ureteroileal anastomosis strictures after radical cystectomy and orthotopic ileal neobladder

Objective： To discuss the management of benign ureteroileal anastomosis strictures after radical cystectomy and orthotopic ileal neobladder. Method： From January 2003 to June 2012, 395 patients with bladder cancer had been treated with radical cystectorny and orthotopic ileal neobladder. Ten patients with benign uret-eroileal anastomosis strictures after orthotopic ileal neobladder reconstruction had been observed, and were treated with ureteroscopy expansion, endoscopic retrograde/pereutaneous antegrade balloon dilatation, endoscopic incision or open repair. Double-J ureteral stents were used for three-six months after the above procedures. Result： Of the ten patients, the stricture could not be passed with a guide wire in one patient （one stenosis）, which furtherly un-derwent open repair. During the follow-up period of 36 months hydronephrosis improved. Others were received endoscopic procedures. Three of them （four stenoses） were treated with ureteroscopy expansion. Two of them （three stenoses） were treated with endoscopic incision. Four of them （four stenoses） were treated with endoscopic retrograde/percutaneous antegrade balloon dilatation. During the median follow-up period of 25 months （9-72 months）, five cases （seven stenoses） had obvious improvement in hydronephrosis, while hydronephrosis didn＇t be-come more serious in two cases （two stenoses）. However, two cases （two stenoses, strictures length 1.2 cm, 1.5 cm） had recurred and open repairs became inevitable. Conclusion： Endoscopic technique can be the first choice for benign ureteroileal anastomosis strictures because of its easy access and less invasion. Open repair remains the gold standard for management of ureteroileal anastomosis strictures. For patients with ureteroileal anastomosis stric-tures longer than lcm, open repair should be considered as the first choice.