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目的 比较输尿管肠管的直接吻合和黏膜隧道式、袖口乳头式抗返流吻合术式的并发症发生率 ,为临床术式的选择提供指导。 方法 6 3例可控性尿流改道术 ,其中 2 4例采用输尿管肠管直接吻合术 (直接吻合组 ) ,39例采用抗返流吻合术 (抗返流吻合组 )。比较直接吻合组和抗返流吻合组术后吻合口狭窄、输尿管返流、肾功能损害及尿路感染等并发症的发生率。术后随访时间 3个月至 6年 ,平均 2 6个月。 结果 78条输尿管肠管抗返流吻合者 ,术后 12条输尿管出现吻合口狭窄。而直接吻合组 4 8条输尿管仅 1条出现吻合口狭窄 ,两者差异有显著性 (χ2 =4 375 ,P <0 0 5 )。抗返流吻合组和直接吻合组术后输尿管返流、肾功能损害及急性尿路感染发生率差异无显著性。结论 黏膜隧道式、袖口乳头式抗返流吻合术后输尿管吻合口狭窄发生率较直接吻合术高。对可控性尿流改道的输尿管肠管吻合宜选择直接吻合术。
Objective To compare the direct anastomosis of ureteral intestine with the incidence of mucosal tunneling and cuff nipple anti-reflux anastomosis, and to provide guidance for the selection of clinical procedures. Methods Twenty-three controllable urinary diversions were performed. Twenty-four of them received direct ureteral enterostomy (direct anastomosis) and 39 received antireflux anastomosis (antireflux anastomosis). The incidences of complications such as anastomotic stenosis, ureteral reflux, renal dysfunction and urinary tract infection were compared between the direct anastomosis group and antireflux anastomosis group. The follow-up time was 3 months to 6 years with an average of 26 months. Results 78 ureter intestinal anti-reflux anastomosis, postoperative 12 ureteral anastomotic stenosis. The anastomotic stricture was found in only 48 of 48 ureters in direct anastomosis group (χ2 = 4 375, P <0 05). There was no significant difference in the incidence of ureteral reflux, renal dysfunction and acute urinary tract infection between the anastomosis-resistant group and the direct anastomosis group. Conclusions The incidence of ureteral anastomotic stenosis after mucosal tunneling and cuff nipple antireflux anastomosis is higher than direct anastomosis. On the controllable urethral diversion of the ureter intestinal anastomosis should choose direct anastomosis.