经瘘道插管造影联合输尿管内顺行置管诊治复杂尿瘘

摘要

目的：总结复杂尿瘘的治疗经验,探讨一种可以应用于复杂尿瘘的新的诊治方法。方法：对同时行膀胱癌Bricker 术和直肠癌Hart mann 术且术后出现漏尿的患者,在常规输尿管镜检查无法进行且B 超、I VU、CT、MRU 等手段无法明确瘘口位置的情况下,尝试在DS A 机透视下经瘘道插管造影,明确瘘口位于输尿管下段,然后行患侧肾脏穿刺造瘘并经造瘘处顺行置入双J 管,以期治愈尿瘘、保护患侧肾脏功能。结果：治疗后瘘口愈合,随访半年,查肾功能正常,B 超示患肾无明显积水。结论：经瘘道插管造影联合输尿管内顺行置管法避免了再次手术且保留了患侧的肾脏功能,适用于复杂尿瘘的诊断和治疗,尤其适用于无法明确瘘口位置的患者。%Objective:To discuss a new method for the diagnosis and treatment of complex urinary fistula by summarizing our successful experiences .Methods:An old patient who had bladder carcinoma and rectal cancer con-currently got leakage of urine after the procedures including Bricker operation and Hart mann operation si multaneous-ly.Firstly,thepreciselocationoftheorificiumfistulae wasdefinitedbyintubationandvisualizationthroughthefis-tuloustractatthecircumstanceof DSAfluoroscopy;thenpuncturationandfistulizationwereoperated;finally,one double-J catheter was put into i mpaired ureter .Results:Urinary fistula was cured after these procedures .Renal func-tion and ultrasound figure of the patient was nor mal half a year later .Conclusions:This method could be applied to curecomplicatedurinaryfistula,especiallyforpatients whoselocationoforificiumfistulaecouldnotbefound.