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目的:探讨突发医源性输尿管长段缺损的应对策略。方法:回顾性分析6例因输尿管镜碎石而导致输尿管长段缺损的治疗过程。结果:3例行患侧肾切除术,术后恢复良好;1例行离体输尿管复位术,术后3个月出现患侧输尿管挛缩,再行回肠代输尿管术;2例行膀胱肌瓣输尿管成形术。后3例患者术后分别随访12个月,行泌尿系B超、静脉尿路造影及磁共振水成像检查,均提示左肾轻度积水,肾功能检查正常。结论:对于突发医源性输尿管长段缺损的患者,如果对侧肾功能正常,患侧肾重度积水,宜行患肾切除术;其他患者均应根据医院自身条件分Ⅰ期或Ⅱ期手术恢复输尿管的连续性,保护患者肾功能。
Objective: To discuss the strategy of sudden ureteral long segment defect. Methods: A retrospective analysis of 6 cases of ureteral lithotripsy caused by the treatment of long ureteral defects. Results: 3 cases underwent ipsilateral nephrectomy and recovered well after surgery. One case received ex vivo ureteral decompression, and the ipsilateral ureter contracture occurred 3 months after operation, followed by ileal ureter surgery. 2 cases underwent bladder myocutaneous ureter Angioplasty. The last three patients were followed up for 12 months respectively. Urine B ultrasound, intravenous urography and magnetic resonance imaging were used to show left mild hydronephrosis and normal renal function. Conclusion: For patients with sudden iatrogenic ureteral long segment defect, nephrectomy should be performed if the contralateral kidney function is normal and the ipsilateral kidney has severe hydronephrosis. Other patients should be divided into stage Ⅰ or Ⅱ according to the hospital’s own conditions Surgical restoration of ureteral continuity, protection of renal function in patients.