摘要目的 总结改良回肠代输尿管术(Yang-Monti术)治疗长段输尿管缺损的经验.方法 回顾性分析2015年3-11月应用Yang-Monti回肠代输尿管术治疗的2例长段输尿管缺损患者的临床资料.例1,男,75岁;诊断为上段输尿管肿瘤并孤立肾,肾盂至膀胱的长度为22 cm;术前血肌酐100 μmol/L,尿素氮5.7 mmol/L,C1-98 mmol/L.例2,女,41岁;诊断为左侧医源性输尿管中下段损伤,损伤段长度为15 cm;术前血肌酐70 μmol/L,尿素氮5.1 mmol/L,C1-100 mmol/L,患肾GFR12.7 ml/min.2例均行肠管横向重新配置的Yang-Monti回肠代输尿管术替代输尿管.2例均取距回盲部＞15 cm、低位活动度较大的回肠段,例1切取约10.0 cm,例2切取7.5 cmT,保留回肠段系膜,例1关闭系膜裂孔,将回肠段拉入腹膜后腔隙;例2于降结肠系膜开窗后拉入腹膜后间隙.两例均将回肠段分为3段,每段为2.5 ～3.0 cm,将3段肠管沿肠管轴方向切开,再将展开的肠管片转动90.后,用4-0可吸收线连续缝合连接3段肠管片,用F16尿管作内支撑,将连接好的肠管片重新卷管,用4-0可吸收线连续缝合成肠代输尿管,使肠管长度分别变成约22 cm和18 cm.肠代输尿管内置入两根F6双J管后,近端与肾盂、输尿管断端吻合,远端与膀胱顶、膀胱后壁吻合.结果 例1手术时间140 min,术中出血量200 ml.例2手术时间180 min,术中出血量220 ml.两例术中、术后均无明显并发症发生.术后3个月复查静脉肾盂造影示,肠代输尿管通畅,例1右肾积水明显改善,例2尿路弓流通畅.术后6个月随访,例1血肌酐112 μmol/L,尿素氮6.1 mmol/L,C1-106 mmol/L;例2血肌酐79 μmol/L,尿素氮5.9 rmool/L,Cl-103 mmol/L.例2术后3个月和6个月的患肾GFR分别为24.9 ml/min和22.1 ml/min.结论 对于长段输尿管缺损、无法用尿路组织替代的患者,Yang-Monti回肠代输尿管术是一种可选的手术方法,该术式并发症较少,可提高患者生活质量.

abstractsObjective We summarized the clinical experience of modified ileal ureter substitution for treating long segment ureteral defection.Methods We retrospectively analyze the clinical data of 2 patients with long segment ureteral defect who treated with Yang-Monti ileal ureter substitution between March 2015 and November 2015.One 75 years old male patient was diagnosed as upper ureteral malignance and solitary kidney.The length of defection from renal pelvis to bladder was 22 em.His serum creatinine was 100 μmol/L,blood urea nitrogen was 5.7 mmol/L,serum chloride was 98 mmol/L.Another one 41 years old female patient was diagnosed as middle and lower ureteral iatrogenic injury.The traumatic length was 15 cm.Her serum creatinine was 70 μmol/L,blood urea nitrogen was 5.1 mmol/L,serum chloride was 100 mmol/L.they were both treated by Yang-Monti ileal ureter substitution.The ileal intestinal segment was used for the ureteral replacement,which were more than 15 cm to the ilealcecum.The length of intestine was 10.0 cm and 7.5 cm,respectively.The ileal mesentery was preserved.After closing the mesangial hiatus,the ileal segment was pull into the retroperitoneal space and pulling out via descending colonic mesangial window.The ileal segment was divided into three parts,which was 2.5 to 3.0 cm in each part.Each part was opened via long axis and then rotated 90 degree.The 4-0 absorable suture was used to suture the edge of each intestinal part continuously.The sutured intestine was re-tubularized,using 4-0 absorable suture and the F16 catheter was used as the tube model.The length of reconstructed ureter was 22 cm and 18 cm,respectively.The neo-ureter was re-anastomosed with renal pelvis and bladder wall.Two F6 double J stents were placed in the neo-ureter.Results The operative time was 160 min and blood loss was 200 ml in the first case.In the second case,the operative time was 180 min and blood loss was 220 ml.No significant complications were noticed intra-operation and post-operation.Six months after operation,the male patient's serum creatinine was 112 pmol/L,blood urea nitrogen was 6.1 mmol/L,serum chloride was 106.0 mmol/L and electrolytes were normal.In another patient,serum creatinine was 79 μmol/L,blood urea nitrogen was 5.9 mmol/L and serum chloride was 103.0 mmol/L.The GFR was 24.9 ml/min and 22.1 m]/min 3 and 6 months after operation,respectively.Ureteral obstruction wasn't detected on IVU images 3 months after operation.Conclusions For patient with long ureteral defect,which cannot be replaced by other urinary tissue,YangMonti ileal ureter substitution is one of the optional modalities.As a new technique of ureteral substitution,Yang-Monti ileal ureter substitution is simple and fewer complications and can improve the quality of life in patient compared with traditional ureteral substitution.