气膀胱腹腔镜输尿管移植术  

Pneumocystoscopic Cohen ureteric reimplantation: Report of 11 cases

作　　者：毕允力[1] 阮双岁[1] 肖现民[1] 陆毅群[1] 王翔[1] 葛琳娟[1] 

机构地区：[1]复旦大学附属儿科医院外科,上海200032

出　　处：《中华小儿外科杂志》2006年第2期78-80,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的介绍应用气膀胱腹腔镜（pneumovesicoscopy）行Cohen输尿管移植术的体会。方法2002年11月-2004年12月治疗11例患儿，年龄3个月～11岁，平均4．4岁。男5例，女6例。膀胱输尿管反流8例（双侧3例，重复肾重复输尿管反流1例），输尿管末端狭窄输尿管全程扩张2例，重复肾上半肾积水输尿管扩张输尿管囊肿1例，总共16根输尿管。手术方法：经膀胱镜注CO2气体扩张膀胱，膀胱镜观察下在脐下以带针缝线经皮穿透膀胱全层做牵引线，鞘管（trocar）沿牵引线穿刺插入膀胱与牵引线固定。同法两侧放置操作鞘管。经中线鞘管目镜观察，两侧鞘管操作。同开放手术行Cohen输尿管移植。术后不放输尿管支撑管仅留置导尿管。结果11例手术均获得成功，无中转开放。手术时间120-300min，平均213min。术后5～7d拔除导尿管出院。术后随访2～14个月，10例无尿路感染发生，尿常规检查正常，其中3例随访，MCU检查原4～5级反流消失。1例出现吻合口狭窄伴尿路感染，予保守治疗控制感染成功。结论在熟练掌握腹腔镜分离缝合技术基础上。气膀胱腹腔镜手术行Cohen输尿管移植术可取得良好的手术效果。Objective To review our experience of pneumocystoscopic Cohen ureteric reimplantation in 11 children. Methods From Nov. 2002 to Dec. 2004, 11 cases （male 5 and female 6, aged from 3 months to 11 years） underwent pneumocystoseopic Cohen ureteric reimplantation in this institute. Among them, 8 cases suffered from vesieoureteral reflux （VUR）, 2 with vesicoureteral junction obstruction, and the other one with ureterocele of upper moiety of duplicated kidney. A troear was in serted into the bladder after CO2 was insufflated to the bladder through cystoscope. Other 2 trocars were inserted laterally in the same way. Cohen procedure was done through the lateral trocars. No ureteral stent was placed. And a Foley catheter was applied at the end of the procedure. Results All procedures were accomplished without conversion. The duration of operations ranged from 120 min to 300 rain （mean 213 min）. Foley catheter was removed in 5-7 days. All patients were followed up from 2 to 14 months. Ten cases were free of urinary tract infection （UTI）. And the other one with UTI was successfully controlled by conservative treatment. Conclusions The satisfactory results can be gained in children underwent pneumocystoscopic Cohen ureteric reimplantation.

关 键 词：外科学 腹腔镜 输尿管 移植 

分 类 号：R726.9[医药卫生—儿科]