| Objective: To investigate the long segment ureteral injury after ileal bladder tissue and muscle flap are two alternative treatment when the ureter, ease of surgical procedures, survival of alternative materials, the effect of anti-reflux, histocompatibility and postoperative clinical manifestations providing treatment and can learn the theoretical basis for clinical use.Method: To retrospective analysis 21 cases oflong segment ureteral injury patients in the PLA 252 nd Hospital Department Urology of Baoding city from 2009 September to 2014 December, 21. Respectively used Intestinal generation ureter and bladder muscle flap surgery generation ureter operation. According to treatment methods were divided into A group of 9 cases, taking the ileal ureter injury operation,12 cases in group B,taking the bladder muscle flap generation ureteral injury operation, Contrasted the clinical data, Comparied of two operative time, intraoperative bleeding volume, postoperative anal exhaust time, postoperative ambulation time, indwelling catheter time and hospitalization time. Preoperative and postoperative 4 weeks on A, B group were intravenous pyelography(IVP), checked the improvement of kidney water and the patency in replacement of ureter; Preoperative and 6 weeks after operation, the A and B group were measured in urine routine, blood urea nitrogen,creatinine and serum electrolyte levels; A and B groups were underwent bladder reflux of contrast 4 months after of operation, checked whether the reflux; A, B groups were compared by diuresis renogram and ultrasound. 6 months after operation, checked the urinary drainage. Compared the incidence of A, B two groups of patients with postoperative complications.Result:1 Operation of 21 patients were successfully completed.The operative time, bleeding volume, postoperative anal exhaust time, postoperative ambulation time, indwelling catheter time and hospitalization time in the A group were:(110.6± 20) minutes,(171.7± 38.1) ml,(2.2± 0.3) days,(3.2 ±0.4) days,(9.3±1) days,(13.4 ±1.3) days.The operative time,bleeding volume, postoperative anal exhaust time, postoperative ambulation time, indwelling catheter time and hospitalization time in the B group were:(94.6 ±11.8) minutes,(141.7±26.6) ml,(2±0.2) days,(2.9±0.4) days,(8.5±0.5) days,(12.3±1.2) days.Analysised by statistical through operation time,intraoperative bleeding volume,postoperative anal exhaust time, postoperative ambulation time, indwelling catheter time and hospitalization time of the two groups showed that, operation time of patients in the B group were shorter than the A group, t=2.298, P =0.033, P <0.05,the difference had statistically significant. The bleeding volume in B group was less than in A group,t=2.131,p=0.046,p<0.05,the difference had statistically significant.Anal exhaust time, postoperative ambulation time, indwelling catheter time and hospitalization time in group B were better than in group A,the t values were 2.194, 2.280, 2.366, 2.139, the p values were 0.041, 0.034, 0.029, 0.046, the P value were <0.05,the difference had statistically significant.2 Preoperative and postoperative 4 weeks on A, B group were intravenous pyelography(IVP), All the patients in A group after ileal ureter operation were unobstructed,compared with the preoperative hydronephrosis reduced,(t=2.238, P =0.040, P <0.05),the difference had statistically significant. All the patientsin B group after bladder muscle flap generation ureteral segment operation were unobstructed, compared with the preoperative hydronephrosis reduced(t=4.282, P =0.000, P <0.01), the difference had statistically significant. The comparison of hydronephrosis between A and B groups in preoperative, it was no difference in degree of hydronephrosis between the two groups(t=0.189, P =0.852, P >0.05), The comparison of hydronephrosis between A and B groups 4 weeks after operation, hydronephrosis improvement in group B was better than that of A group after operation(t=2.233, P =0.038, P <0.05).3 Preoperative and postoperative six weeks observing secretions found in the urine, the former A, B two groups of patients showed no significant intraoperative urine secretion; after group A urine secretion in one case more yellow with smell, two cases have fewer secretions, and the remaining six cases no obvious secretions. Group B urine were no secretions more, two cases have fewer secretions, and the remaining 10 cases no obvious secretions.Preoperative and 6 weeks after operation, the A and B group measured in routine urine founded, routine urine showed normal in both of the two group before operation, the white blood cells increased significantly in 1 cases of group A after operation,caused of urinary tract infection; There were no urinary tract infection in group B. Preoperative and 6 weeks after operation, the A and B group measured blood urea nitrogen, creatinine and serum electrolyte levels, compared biochemical indicators before and after the operation of A, B two groups and analysised by statistical, the various biochemical indexes(Blood urea nitrogen, creatinine, Na+, Cl, HCO3-) had no significant difference between before and after operation in group A, P >0.05, showed no effect on renal function.The various biochemical indexes had no significant difference between before and after operation in group b, P >0.05, showed no effect on renal function.4 A and B groups were underwent bladder reflux of contrast 4 months after of operation, contrast agent mild refluxed to the generation of the lower ileum ureter when bladder filling and voiding of 2 cases in group A, a small amount of urine in renal pelvis, the remaining 7 patients without the occurrence of reflux, the incidence of reflux was 22.2%. contrast agent mild refluxed to the generation of the lower ileum ureter when bladder filling and voiding of 1 cases in group B, a small amount of urine in renal pelvis, the remaining 11 patients without the occurrence of reflux, the incidence of reflux was 8.3%.5 Six months after operation, checked the urinary drainage,there was 1 cases urinary tract obstruction exists in group A, ureteroscopy founded 1 cases of ureteral stenosis in patients with ileum at the connection, ureteral balloon dilatated and became better, 3 months as a time interval, a total of 3 times, checked diuresis renogram and ultrasound again, the results suggest that the drainage unobstructed, renal pelvis seeper alleviating, the other 8 patients of upper urinary tract drainage, hydronephrosis significantly reduce, the occurred of anastomotic stenosis was 11.1% in A group. There were no poor drainage inbilateral upper urinary tract of group B, no stenosis was founded under ureteroscopy in ureter and bladder muscle flap at the connection, hydronephrosis significantly reduce.6 In group A,there were 1 cases with urinary tract infection, 2 cases with vesicoureteral reflux, 1 cases with urinary tract obstruction and 1 cases with urinary tract stenosis; In group B,there were only 1 cases with vesicoureteral reflux. There were no significant difference the rate of all kinds of complications between A and B two groups.Conclusion:For ureter defect patients,bladder muscle flap generation ureter operation was better than Ileal ureter angioplasty. It could restore the continuity of urinary tract, improve the renal function, simple operation,application of safety, less complications, clear curative effect, not only reduce the medical cost and relieve the pain of patients, and is worthy of clinical promotion. |
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