Objective To evaluate the benefit of placement of dual double-J stents following high-pressure balloon angioplasty for treatment of ureter-ileum anastomosis stricture after total bladder resection. Methods Seventeen patients (11 males and 6 females, mean age 56.65 ±6.28 years, 23 sides) undergoing total bladder resection were included in this study. Unilateral and bilateral ureteral stricture occurred postoperatively in 11 and 6 patients, respectively; 13 patients had ureter-ileum bladder anastomosis stricture after ileal bladder substitution, and 4 patients had ureter-ileum stricture after orthotopic construction of ileal neobladder. The control group consisted of 21 patients undergoing open surgery. Results In the double-J stenting group, the effective rate was 82.6% (19/23), similar to that of 85.7% (18/21) in the control group (P>0.05). Compared with the control group, the stenting group showed a significantly reduced mean time of operation (87.42±10.35 min vs 34.12±7.52 min, P<0.05), intraoperative blood loss (203.16±32.67 ml vs 21.54±6.15 ml, P<0.05), and mean postoperative hospital stay (10.12±1.19 vs 3.24±0.35 days, P<0.05). Conclusion As a safe and minimally invasive approach to the management of ureter-ileum bladder anastomosis stricture, placement of dual double-J stents following high-pressure balloon angioplasty produces a effect comparable with that of open surgery.%目的 探讨高压球囊扩张术后留置双D-J管治疗膀胱全切术后输尿管回肠吻合口狭窄的疗效.方法 采用高压球囊扩张术后留置双D-J管治疗输尿管同肠吻合口狭窄17例(23侧);男11例,女6例,平均年龄56.65±6.28岁;单侧狭窄11例,双侧狭窄6例;回肠膀胱术后吻合口狭窄13例,原位回肠新膀胱术后吻合口狭窄4例;对照组采用开放手术治疗膀胱全切术后输尿管回肠吻合口狭窄21例(25侧).结果 试验组17例(23侧)全部随访,治愈12侧,好转7侧,无效4侧,总有效率达82.6%.对照组随访18例(21侧),治愈11侧,好转7侧,无效3侧,总有效率达85.7%,两组间疗效比较无明显差异(P>0.05);试验组平均手术时间(34.12±7.52)min,对照组平均手术时间(87.42±10.35)min,两组间比较差异有统计学意义(P<0.05);试验组手术平均失血量(21.54±6.15)ml,对照组手术平均失血量(203.16±32.67)ml,两组间比较差异有统计学意义(P<0.05);试验组术后平均住院天数(3.24±0.35)d,对照组术后平均住院天数(10.12±1.19)d,两组间比较差异有统计学意义(P<0.05).结论 采用高压球囊扩张术后留置双D-J管治疗输尿管回肠吻合口狭窄创伤小、安全,疗效较开放手术无明显差异.
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