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目的 探讨关于下尿路良性机械性或动力性梗阻、膀胱功能丧失后引起的肾盂输尿管重度扩张积水肾功能受损 ,行双侧输尿管皮肤乳头术后防止肾功能进一步受损的有效方法。方法 (1)旷置膀胱、腹膜外游离、理直迂曲的输尿管 ,左侧输尿管由腹膜后引至右侧 ,选择适当位置作双筒皮肤乳头术 (单肾者在同侧 )。 (2 )输尿管中置入适当大小的多孔硅胶支架引流管至肾盂内 ,使肾盂尿液直接引出体外 ,以后定期换管。结果 本组 12例术后肾功能均得到明显改善 ,无继续恶化 ,随访最长者 2 0年 ,能劳动。结论 由于输尿管扩张后其蠕动力差 ,同时行皮肤乳头术后出口很容易收缩狭窄 ,而致肾盂内压力高 (本组测量达 18～ 2 6 cm H2 O) ,残余尿多 ,使肾功能进一步破坏且易感染 ,采用多孔硅胶管内置长期引流 ,定期换管 ,可防止肾功能恶化 ,是一种有效简便的解决方法。
Objective To discuss the effective method of preventing the renal function from deteriorating after benign mechanical or dynamic obstruction of lower urinary tract and impaired hydronephrosis of renal pelvis and ureter caused by loss of bladder function. Methods (1) exclusion of the bladder, extraperitoneal free, straight tortuous ureter, the left ureter from the retroperitoneal lead to the right, select the appropriate location for binocular skin nipple surgery (single kidney in the same side). (2) ureteral into the appropriate size of the porous silicone stent drainage tube to the renal pelvis, the pelvic urine leads directly to the body, after regular tube change. Results The postoperative renal function of 12 patients in this group were significantly improved, no further deterioration, the longest follow-up of 20 years, able to work. Conclusions Due to poor peristalsis after ureteral dilatation and simultaneous exit of dermal papillae, it is easy to contract and narrow the renal pelvis with high intra-pelvic pressure (18 ~ 26 cm H 2 O in this group), more residual urine and further renal function Damage and susceptible to infection, the use of porous silicone tube built-in long-term drainage, regular tube change to prevent deterioration of renal function, is an effective and easy solution.