目的：探讨应用回肠代输尿管术治疗医源性长段输尿管损伤的疗效。方法：总结自2010年8月至2014年9月期间接受回肠代输尿管术的9例医源性长段输尿管损伤患者的临床资料，其中男性3例，女性6例，中位年龄40岁。中位输尿管损伤长度为20 cm，范围13~25 cm。常见医源性输尿管损伤原因为泌尿外科手术6例，妇产科手术2例，普外科手术1例。9例患者均行回肠代输尿管术，术后留置输尿管内双J管1~2个月。对所有入组患者进行门诊及电话随访，了解其并发症及术后肾功能情况，采用Clavien并发症分级系统对术后并发症进行分级。结果：9例手术均顺利完成，手术时间为203~394 min，平均（278.1±68.8） min，估计出血量为10~1 000 mL（中位数200 mL）， 平均住院时间为（16.8±7.5） d。4例（44.4%）患者发生术后并发症，均为Clavien Ⅰ~Ⅱ级轻微并发症，其中不全肠梗阻3例（33.3%）， 近端吻合口漏1例（11.1%）。中位随访时间11个月，8例（88.9%）患者术后肌酐水平较术前相比有所改善或稳定。随访过程中3例（33.3%）患者出现轻度肾积水，但无明显症状亦不需特殊处理；1例（11.1%）患者发生短期泌尿系感染，需口服抗生素治疗；未发现代谢性并发症发生。结论：回肠代输尿管术是一种可选择的尿路重建方式，尤其对难治性医源性长段输尿管损伤的治疗效果满意，其远期临床疗效仍需进一步观察。

Objective：To investigate the efficacy of ileal ureteric replacement in the treatment of iatrogenic long segment ureteric injuries. Methods: The hospital records of 9 cases with iatrogenic long segment ureteric injuries during Aug. 2010 to Sept. 2014 treated with ileal ureteric replacement were retrospectively reviewed and followed-up postoperatively. The patients included 3 males and 6 females with a median age of 40 years. The length of injury segment was 13-25 cm (median 20 cm). The etiology of the iatrogenic injury was urological surgery (n=6), gynecological surgery (n=2) and general surgery (n=1), respectively. The ureter stent was removed in 1-2 month postoperatively in all the 9 cases. Results: All the operations were successful. The operation time was 203-394 min, with the average of (278.1±68.8) min. The bleeding volume was 10-1 000 mL, with the median of 200 mL. The mean length of hospital stay was (16.8±7.5) days. Four minor complications (Grade Ⅰ-Ⅱ) developed, including 3 ileus (33.3%) and 1 proximal anastomotic leakage (11.1%). The median followup time was 11 months, serum creatinine decreased or remained stable in 8 patients (88.9%). Three patients (33.3%) developed mild hydronephrosis and shorttime urinary tract infection was seen in 1 patient (11.1%). Metabolic acidosis was not detected during the followup. Conclusion: Ileal ureteric replacement is a safe and effective method in patients with complex or difficult iatrogenic long segment ureteric injuries.