北京大学学报（医学版）2025，Vol.57Issue(4)：670-675,6.DOI:10.19723/j.issn.1671-167X.2025.04.007
结石相关输尿管狭窄的上尿路修复手术技术与临床结局
Surgical techniques and clinical outcomes of upper urinary tract reconstruction for stone-related ureteral strictures
摘要
Abstract
Objective:To summarize the surgical strategies and to evaluate the clinical outcomes of up-per urinary tract reconstruction in patients with stone-related ureteral strictures.Methods:This retro-spective study included 71 patients diagnosed with ureteral strictures secondary to urinary stones who un-derwent upper urinary tract reconstructive surgery at Peking University First Hospital between March 2014 and November 2023.Patient data were collected,including demographic characteristics,clinical presen-tation,laboratory results,imaging findings,surgical procedures,and follow-up outcomes.Ureteral stric-tures were classified according to anatomical location into upper,middle,lower,or multiple segments.Surgical procedures were carried out depending on the stricture characteristics.Surgical success was de-fined as resolution or improvement of clinical symptoms,radiographic improvement or stabilization of hy-dronephrosis,and maintenance of normal and stable renal function.Results:Among the 71 patients,36(50.7％)had strictures in the upper ureter,9(12.7％)in the middle ureter,15(21.1％)in the lower ureter,and 11(15.5％)had multifocal ureteral strictures.The median stricture length was 5.0 cm(interquartile range:3.0-15.0 cm).Surgical approach selection was individualized based on the location and extent of the stricture.For upper ureteral strictures,the most frequently employed techniques were oral mucosal graft ureteroplasty(13/36,36.1％)and appendiceal flap ureteroplasty(8/36,22.2％).Other options included ureteroureterostomy and ileal ureter replacement for longer or more complex strictures.In middle ureteral strictures,treatment was stratified by length:balloon dilation(1/9,11.1％)and ureteroureterostomy(1/9,11.1％)were applied in shorter strictures,while oral mucosal graft ureteroplasty(3/9,33.3％)and ileal ureter replacement(4/9,44.4％)were reserved for longer segments.For lower ureteral strictures,ureteral reimplantation into the bladder was the most common approach(10/15,66.7％),often combined with a psoas hitch or Boari flap when necessary.All the patients with multiple segmental strictures underwent ileal ureter replacement due to the extensive nature of the disease.The median follow-up period was 14.2 months(range:6.1-107.1 months).During follow-up,69 of 71 patients(97.2％)achieved surgical success.Conclusion:Stone-related ure-teral strictures present with considerable heterogeneity in terms of anatomical location,length,and com-plexity.Careful preoperative evaluation and individualized surgical planning are critical to successful re-construction.With appropriate selection of surgical methods,favorable long-term clinical outcomes can be achieved in the majority of patients.关键词
肾积水/输尿管狭窄/修复重建/输尿管镜/碎石术Key words
Hydronephrosis/Ureteral stenosis/Reconstruction surgery/Ureteroscopy/Lithotripsy分类
医药卫生引用本文复制引用
余霄腾,李志华,杨昆霖,周利群,李学松,赵峥,黄奕瑄,李新飞,陈昶甫,赵方舟,应鸿刚,陶子豪,张一鸣,徐丽清..结石相关输尿管狭窄的上尿路修复手术技术与临床结局[J].北京大学学报（医学版）,2025,57(4):670-675,6.基金项目
国家自然科学基金(82400785)Supported by the National Natural Science Foundation of China(82400785) （82400785）
