本文選題：Bricker術 + 輸尿管-腸吻合口狹窄��； 參考：《浙江大學》2014年碩士論文

【摘要】：目的：探討經(jīng)皮順行輸尿管軟鏡聯(lián)合鈥激光,球囊擴張導管在Bricker術后輸尿管梗阻中的應用價值,為該病的微創(chuàng)處理提供一個新的思路。方法：2010.10-2013.9期間邵逸夫醫(yī)院收治了5例膀胱全切,Bricker回腸膀胱術后出現(xiàn)輸尿管梗阻的患者。5例均為男性,年齡57-77歲,平均64歲,術后8～168個月(平均66個月)出現(xiàn)梗阻。單側輸尿管-回腸吻合口狹窄3例,其中左側2例,右側1例,其中1例合并右輸尿管中下段結石；雙側輸尿管-回腸吻合口狹窄1例,伴雙側輸尿管下段結石；右側輸尿管-回腸吻合口完全梗阻(閉鎖)1例。術前均在B超或CT引導下行經(jīng)皮腎穿刺造瘺,置入F8或F12造瘺管引流腎積水2周。通過B超、CT、KUB+IVP.順行尿路造影檢查明確梗阻部位、長度及伴發(fā)結石數(shù)量。術中用Peel-away筋膜擴張器擴張至F14或F16,通過擴張鞘置入輸尿管軟鏡,輸尿管軟鏡沿輸尿管下行至回腸-輸尿管吻合處,在梗阻遠端用膀胱軟鏡或輸尿管硬鏡直視觀察下采用順行結合逆行方式行腔內(nèi)鈥激光碎石,狹窄段內(nèi)切開聯(lián)合球囊擴張導管擴張。術后留置F6D-J管于8周后拔除,并定期隨訪腎積水及結石情況。 結果：平均手術時間95min,術中失血5-20m1,術后平均住院天數(shù)2.5d。5例患者均一期處理吻合口狹窄或閉鎖并留置D-J管,伴發(fā)結石者同時處理結石,隨訪3-18月(平均9月),所有病例腎功能恢復正常,無結石復發(fā),3例術后無腎積水,1例遺留輕度腎積水,1例拔除D-J管4月后腎積水進行性加重,考慮吻合口狹窄復發(fā)予膀胱軟鏡下逆行留置D-J管并予每3月更換D-J管后腎積水明顯消退。 結論：經(jīng)皮腎穿刺順行輸尿管軟鏡聯(lián)合鈥激光及球囊擴張治療Bricker術后輸尿管-腸段吻合口梗阻安全,有效,短期效果確切,可減少創(chuàng)傷,減輕患者痛苦,可望替代開放手術或長期腎造瘺,為該病的微創(chuàng)治療提供一個新的思路。
[Abstract]:Objective: to explore the value of percutaneous anterograde ureteroscopy combined with holmium laser and balloon dilation catheter in the treatment of ureteral obstruction after Bricker, and to provide a new idea for minimally invasive management of ureteral obstruction. Methods five patients with ureteral obstruction after cystectomy Bricker ileal bladder operation were admitted to run Shaw Hospital from October to March 2010..5 cases were male, aged 57-77 years (mean 64 years). Obstruction occurred in 8 ~ 168 months (average 66 months) after operation. There were 3 cases of unilateral uretero-ileal anastomotic stricture, including 2 cases on left side and 1 case on right side, in which 1 case was complicated with middle and lower ureteral calculi, 1 case had bilateral uretero-ileal anastomotic stoma stricture, 1 case had bilateral distal ureteral calculi. Complete obstruction of right uretero-ileal anastomosis (1 case with atresia). Percutaneous nephrostomy was performed under the guidance of B-ultrasound or CT before operation, and F8 or F12 fistula tube was placed to drain hydronephrosis for 2 weeks. KUB IVP. Anterograde urography was used to determine the location, length and number of stones associated with obstruction. The Peel-away fascia expander was used to expand to F14 or F16 during the operation. The soft ureteroscope was inserted into the ureteroscope through the dilatation sheath, and the soft ureteroscope went down to the ileo-ureteral anastomosis along the ureter. Endovascular holmium laser lithotripsy was performed in the distal part of the obstruction with direct observation of soft cystoscopy or ureteroscopy, and dilatation of balloon dilatation catheter was performed in the narrow segment with anterograde combined with retrograde method of holmium laser lithotripsy. The F6D-J tube was removed after 8 weeks and the hydronephrosis and calculi were followed up regularly. Results: the average operation time was 95 min, the blood loss was 5-20 m ~ (1) during operation, and the average days of hospitalization after operation were 2.5d.5. All patients with anastomotic stoma stenosis or atresia were treated with D-J tube in one stage, and the patients with stones were treated with stones at the same time. All cases were followed up for 3 to 18 months (mean September), all cases recovered normal renal function, 3 cases without recurrence of stone and 1 case with mild hydronephrosis after removal of D-J tube, 1 case had progressive aggravation of hydronephrosis after removal of D-J tube for 4 months. After retrograde indwelling D-J tube under soft cystoscopy and replacement of D-J tube every 3 months, hydronephrosis disappeared obviously. Conclusion: percutaneous renal puncture combined with holmium laser and balloon dilatation is safe, effective and effective in the treatment of uretero-intestinal anastomotic obstruction after Bricker. It can reduce the trauma and alleviate the pain of the patients. It is expected to replace open surgery or long-term nephrostomy and provide a new idea for minimally invasive treatment of the disease.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699

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本文編號：1929466