回肠膀胱术后输尿管回肠代膀胱吻合口闭锁的微创治疗

目的：探讨回肠膀胱术（Bricker术）后输尿管回肠代膀胱哟合口闭锁微创治疗的远期疗效。方法：回顾性分析我院2008年1月-2011年6月年治疗的12例Bricker术后输尿管回肠代膀胱吻合口闭锁患者的临床资料，经膀胱镜及磁共振水成像及泌尿系彩超明确诊断，采用顺行结合逆行方式行膣内钛激光切开，术中先经皮。肾顺行插入F5输尿管导管至输尿管远端，注入亚甲蓝，经代膀胱在膀胱软镜下向输尿管遥端穿刺，见有蓝色液体流出后，钬激光切开该处建立通道。术后留置F7号双J管4-6周拔除，并定期随访肾积水情况。结果：8例一次手术成功，2例改开放手术，1例一期行经皮肾穿刺造瘘术，待肾功能恢复后再行微创手术治疗成功，1例孤立伴有慢性肾功能不全，行经皮肾造瘘长期留置造瘘管引流。9例行微创治疗的患者术中无大出血的并发症，随访6-18个月，平均12个月，治愈6例，好转2例，无效1例，总有效率为88．9％。结论：微创经皮肾穿刺顺行输尿管软镜联合电子膀胱镜，并用钬激光治疗Brieker术后输尿管-肠段吻合口闭锁安全，有效，可作为替代开放手术，减少创伤，减轻患者痛苦。

Micro-invasive treatment of ureteral obstruction after the ileal conduit urinary diversion

Objective ： To investigate the efficacy of micro-invasive treatment of ureteral obstruction after the il- eal conduit urinary diversion. Method.. From Jan 2008 to jun 2011, 12 patients with recurrent ureteral obstruction after the ileal conduit urinary diversion, Minimally invasive percutaneous renal puncture and antegrade flexible ure- teroscope combined electronic cystoscopy, indwelling ureteral catheter, and inside incision with holmium ~ YAG laser, one double-J stents were placed in the ureter for 4-6 weeks. During follow-up ultrasound was performed ev- ery 3 months. Result.. Eight cases of successful operation, 2 cases changed to open operation, with no major bleed- ing complications, all patients were followed up for 6-18 months, 6 cases were cured, 2 cases improved, 1 cases are invalid, the total efficiency of 88. 9%. Concluslon;Minimally invasive percutaneous renal punctureand ante- grade flexible ureteroscope combined electronic cystoscopy an inside incision with holmium ： YAG laser treatment of ureteral obstruction after the ileal conduit urinary diversion was and effective.