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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (4): 789-795. doi: 10.19723/j.issn.1671-167X.2025.04.026

• 技术方法 • 上一篇    下一篇

完全3D腹腔镜回肠代双侧输尿管联合膀胱扩大术修复放射治疗后双侧输尿管狭窄并膀胱挛缩

黄万伟1, 沙显燊1, 张艺宝1, 伍国豪2, 骆峰2, 陈智慧2, 叶东明2, 李学松3,*(), 赖彩永1,2,*()   

  1. 1. 暨南大学附属第一医院泌尿外科，广州 510630
    2. 暨南大学附属第六医院泌尿外科，广东东莞 523570
    3. 北京大学第一医院泌尿外科，北京 100034
  • 收稿日期:2025-02-12 出版日期:2025-08-18 发布日期:2025-08-02
  • 通讯作者: 李学松, 赖彩永
  • 基金资助:
    广州市科技计划项目(2023A03J0569); 暨南大学医学联合基金(YXZY2022032); 东莞市社会发展科技项目(20231800940732)

Total 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation in the management of post-radiotherapy bilateral ureteral strictures and contracted bladder

Wanwei HUANG1, Xianshen SHA1, Yibao ZHANG1, Guohao WU2, Feng LUO2, Zhihui CHEN2, Dongming YE2, Xuesong LI3,*(), Caiyong LAI1,2,*()   

  1. 1. Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
    2. Department of Urology, The Sixth Affiliated Hospital of Jinan University, Dongguan 523570, Guangdong, China
    3. Department of Urology, Peking University First Hospital, Beijing 100034, China
  • Received:2025-02-12 Online:2025-08-18 Published:2025-08-02
  • Contact: Xuesong LI, Caiyong LAI
  • Supported by:
    the Guangzhou Science and Technology Plan Project(2023A03J0569); the Jinan University Medical Joint Fund Project(YXZY2022032); the Dongguan City Social Development Science and Technology Project(20231800940732)

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摘要：

目的: 探讨完全3D腹腔镜回肠代双侧输尿管并膀胱扩大术修复放射治疗后双侧输尿管长段狭窄合并膀胱挛缩的临床疗效与安全性。方法: 选择2023年10月至2024年6月暨南大学附属第六医院收治的2例因放射治疗导致双侧输尿管长段狭窄合并膀胱容量减少患者的病例资料进行回顾性分析，两例女性患者年龄分别为72、54岁，临床表现均为双侧腰部疼痛、反复畏寒发热，伴随尿频、尿急。术前输尿管狭窄长度分别为左侧10.4 cm、右侧8.7 cm和左侧10.6 cm、右侧11.7 cm；术前经肾造瘘顺行尿路造影评估膀胱容量为90 mL和130 mL。2例患者均采用基于膜解剖的完全3D腹腔镜一期、单一体位的双侧肠代输尿管并膀胱扩大手术，术后定期随访。结果: 手术由同一名拥有20年临床经验的泌尿外科医生完成，手术时间分别为420 min、355 min，术中出血均为50 mL，无需术中输血。术后肛门排气时间分别为第4.5、3天。2例患者围手术期无重大并发症发生。术后2个月拔除输尿管支架，影像结果显示肾积水减轻，输尿管排泄顺畅，膀胱形态对称，膀胱壁光滑。术后2个月造影提示膀胱容量分别为230 mL和250 mL。截至2025年4月，分别随访10、8个月。随访期间，2例患者腰痛及尿频、尿急症状明显缓解，均未出现肠瘘、尿瘘、代谢性酸中毒等并发症。末次随访时，1例患者血清肌酐轻度升高，另1例较术前有所降低，均维持稳定。结论: 基于膜解剖的分离技术有助于游离并显露纤维化的输尿管，减少出血和副损伤。完全3D腹腔镜回肠代双侧输尿管并膀胱扩大术有效解除了输尿管长段梗阻，并提高了膀胱容量。手术方法安全、可行，但仍需更多临床数据来进一步验证其疗效与安全性。

关键词: 输尿管梗阻, 膀胱, 放射治疗, 放射治疗后广泛输尿管狭窄, 回肠代输尿管术, 完全腹腔镜手术

Abstract:

Objective: To retrospectively evaluate the clinical efficacy and safety of total 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation in patients with post-radiotherapy long-segment bilateral ureteral strictures and contracted bladder. Methods: Clinical data of two patients (aged 72 and 54 years) with radiation-induced long-segment bilateral ureteral strictures and reduced bladder capacity, treated at the Sixth Affiliated Hospital of Jinan University from October 2023 to June 2024, were analyzed. Both presented with bilateral flank pain, recurrent chills/fever, urinary frequency, and urgency. Preoperative ureteral stricture lengths were measured as follows: left 10.4 cm and right 8.7 cm in the first case; left 10.6 cm and right 11.7 cm in the second case. Bladder capacity assessed by nephrostomy-assisted antegrade urography was 90 mL and 130 mL respectively. Both underwent single-position, one-stage totally 3D laparoscopic bilateral ileal ureteral replacement and bladder augmentation based on membrane anatomy principles, with regular postoperative follow-up. Results: Procedures were completed by the same experienced urologist. Operative times were 420 min and 355 min, with intraoperative blood loss of 50 mL (no transfusion required). Postoperative bowel function resumed at the end of 4.5 and 3 days. No major perioperative complications occurred. Ureteral stents were removed at 2 months postoperatively, with imaging showing improved hydronephrosis, unobstructed ureteral drainage, symmetrical bladder morphology, and smooth walls. Postoperative bladder capacities were 230 mL and 250 mL. Follow-up durations were 10 and 8 months. Both patients experienced significant relief of flank pain and lower urinary tract symptoms. No complications (enteric fistula, urinary fistula, or metabolic acidosis) were observed. At the final follow-up, one patient had mildly elevated serum creatinine, while the other showed reduced levels compared with preoperative values; both remained stable. Conclusion: Membrane anatomy-based dissection facilitates safe mobilization of fibrotic ureters with minimal bleeding and collateral damage. Total intracorporeal 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation effectively addresses long-segment ureteral obstruction and improves bladder capacity. This approach is technically safe and feasible, though further validation with larger clinical cohorts is warranted.

Key words: Ureteral obstruction, Urinary bladder, Radiotherapy, Radiation-induced extensive ureteral strictures, Ileal ureteral replacement, Totally laparoscopic surgery

中图分类号: 

  • R699

表1

患者基线特征"

Items Case 1 Case 2
Age/years 72 54
Gender Female Female
Affected side Bilateral Bilateral
Etiology Radiotherapy for cervical high-grade squamous intraepithelial lesion Radiotherapy after cervical cancer surgery

Symptom manifestation		 Low back pain, intermittent fever, urinary frequency and urgency Low back pain, intermittent fever,
urinary frequency and urgency
Length of ureteral stricture/cm Left 10.4, right 8.7 Left 10.6, right 11.7
Preoperative hydronephrosis degree Bilateral moderate to severe hydronephrosis Bilateral moderate to severe hydronephrosis
Past surgical history Open pyelolithotomy on the left side Hysterectomy and bilateral adnexectomy
Preoperative management Nephrostomy for 2 months Nephrostomy for 2 months

图1

手术体位及操作孔布局"

图2

完全3D腹腔镜回肠代双侧输尿管并膀胱扩大术手术步骤及模式图"

图3

术前及术后影像学检查"

表2

患者围手术期及术后随访情况"

Items Case 1 Case 2
Surgical method Total 3D laparoscopy Total 3D laparoscopy
Surgical duration/min 420 355
Intraoperative blood loss/mL 50 50
Length of bowel resection/cm 40 38
Perioperative complications None None
Time to flatus passage after surgery/d 4.5 3
Hospital stay duration/d 10 8
Residual urine volume (preoperative/2 months postoperative)/mL 45/50 60/55
Bladder capacity (preoperative/2 months postoperative)/mL 90/230 130/250
24-hour urination frequency (preoperative/2 months postoperative) (16-18)/(9-10) (12-14)/(8-9)
Nocturia frequency (preoperative/2 months postoperative) (3-5)/(1-2) (2-3)/(1-2)
Clean intermittent self-catheterization No No
Base excess/(mmol/L)
  Preoperative +0.8 -1.2
  2 months postoperative -1.8 -2.6
  6 months postoperative -2.2 -2.4
Serum creatinine/(μmol/L)
  Preoperative 118.11 179.63
  1 day postoperative 131.77 180.41
  2 months postoperative 125.31 100.03
  6 months postoperative 136.83 110.67
  8 months postoperative 138.40 107.89
  10 months postoperative 126.65 -
Follow-up duration/months 10 8
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ISSN 1671-167X
CN 11-4691/R
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