目的:观察螺旋状带蒂膀胱肌瓣输尿管成形术修复全程或接近全程输尿管损伤的疗效,探讨膀胱肌瓣修复长段输尿管损伤(>20cm)的手术方式。方法:回顾性分析6例因输尿管上段结石行输尿管镜下碎石术并发的全程或接近全程输尿管损伤患者的治疗过程:男4例,女2例;年龄37~59岁,平均49岁;左侧4例,右侧2例。其中输尿管黏膜全程撕脱2例,自肾盂至膀胱连接处输尿管完全离断4例;损伤长度21~25cm,平均22cm。6例均采用螺旋状带蒂膀胱肌瓣输尿管成形术。术中注意保护患侧膀胱上动脉的完整性,取瓣要循膀胱上动脉走行裁剪。其中5例术中同行肾脏下降固定术和膀胱腰大肌悬吊术,以缩短患侧肾和膀胱间距,1例切瓣卷管后直接与肾盂端吻合。酌情转移带蒂大网膜组织覆盖重建输尿管。结果:6例手术顺利,手术时间1~2h,平均1.5h。5例成形输尿管旁引流管术后第3天拔除,1例因漏尿于术后第10天拔除。6例切口均一期愈合。术后2周复查血肌酐和尿素氮正常,术后8周在膀胱镜下安全拔除双J管。1例术中未同行肾脏下降固定术和膀胱腰大肌悬吊术的患者术后3个月行静脉尿路造影(IVU)检查,发现重建输尿管明显狭窄且伴肾积水,重新置入双J管行保守治疗,2个月后复查ECT示患侧肾脏功能重度受损,于术后6个月行患肾切除术。1例术后6个月IVU复查时发现手术侧轻度肾积水及输尿管轻度扩张,但总肾功能正常。余4例随访2~4年,未见明显异常,IVU检查显示手术侧成形输尿管形态均正常,显影良好,均未发现明显的膀胱输尿管反流,因膀胱容量缩小导致的下尿路症状(LUTS)不明显。结论:螺旋状带蒂膀胱肌瓣输尿管成形术是长段输尿管损伤修复的理想术式,创伤小,并发症少,恢复快,尤其适用于缺损长度超过20cm乃至全程输尿管损伤的修复治疗,有较高的推广价值。 OBJECTIVE: To observe the curative effect of ureteroplasty of spiral pedunculated bladder muscle flap in the treatment of ureteral injury in the whole or near the whole ureter, and to investigate the surgical approach to repair long ureteral injury (> 20cm) with bladder muscle flap. Methods: Retrospective analysis of 6 cases of ureteral calculi due to upper ureteral calculi underwent ureteroscopic lithotripsy. The treatment course included 4 males and 2 females, aged from 37 to 59 years with an average of 49 years. Left 4 cases on the right side and 2 cases on the right side. Including ureteral mucosa avulsion in 2 cases, from the renal pelvis to the bladder junction ureter completely disconnected in 4 cases; injury length 21 ~ 25cm, an average of 22cm. 6 cases were using spiral pedicled bladder muscle ureteroplasty. Intraoperative attention to protect the ipsilateral bladder on the integrity of the artery, take the flap to follow the path of the bladder artery cut. Among them, 5 cases had intraoperative renal descending fixation and bladder psoas suspension, in order to shorten the ipsilateral renal and bladder spacing, and 1 case was directly anastomosed with the renal pelvis after slicing and rolling the vial. Disseminated pedicled omentum tissue covered reconstruction ureter as appropriate. Results: The operation was successful in 6 cases. The operation time was 1 ~ 2 hours and the average was 1.5 hours. In 5 cases, ureteral drainage tube was removed on the third day after operation, and one case was removed due to leakage of urine during the tenth day after operation. 6 cases of incision healed in one time. Two weeks after operation, serum creatinine and urea nitrogen were normal, and double J tube was removed safely under cystoscopy 8 weeks after operation. One patient who did not undergo renal descending fixation and bladder psoas suspension during the operation was examined by intravenous urography (IVU) three months after operation and found that the ureter was stenosed with hydronephrosis and re-placed in double J tube conservative treatment, 2 months after the review ECT revealed severe side effects of renal function, at 6 months after surgery underwent nephrectomy. One case of 6 months after IVU review showed mild hydronephrosis on the operation side and slight ureter dilatation, but the total renal function was normal. The other 4 cases were followed up for 2 to 4 years. No obvious abnormalities were observed. The IVU showed that the shape of the ureter was normal and well-developed. All patients had no obvious vesicoureteral reflux. The lower urinary tract symptoms (LUTS Not obvious. Conclusions: Ureteroplasty of helical pedunculated bladder muscle flap is an ideal method for ureteral injury repair in long segment. It has the advantages of less trauma, less complications and faster recovery. It is especially suitable for the repair of ureteral injury with length more than 20cm or even full length High promotion value.