经腹腔膀胱内途径腹腔镜下输尿管膀胱再植术的临床应用(附8例报告)  

Clinical application of transperitoneal laparoscopic ureteral reimplantation via vesical approach(report of 8 cases)

作　　者：李南南[1] 陈湘[1] 齐琳[1] 何垚[1] 陈志[1] 罗延诚[1] 

机构地区：[1]中南大学湘雅医院泌尿外科,湖南长沙410008

出　　处：《中国内镜杂志》2012年第2期176-179,共4页China Journal of Endoscopy

摘　　要：目的探讨经腹腔膀胱内途径腹腔镜下输尿管膀胱再植术的可行性及临床价值。方法采用经腹腔膀胱内途径行腹腔镜输尿管膀胱再植术治疗8例输尿管出口狭窄患者。6例为单纯性先天性输尿管出口狭窄;1例为输尿管末端结石行输尿管镜钬激光碎石术后9个月出现狭窄,1例为泌尿系结核右肾切除术后左侧输尿管出口狭窄。B超、IVU等检查示重度肾积水5例,中度肾积水3例。结果 8例手术均获得成功。平均手术时间112 min(90～140 min),平均出血量40 mL(30～60 mL),术后1～3 d拔除膀胱外引流管下床活动,无尿漏发生。术后2周拔除导尿管,7～10 d出院,平均住院时间8 d。术后2～3个月拔除双J管。随访3～12个月,B超、IVU和(或)磁共振尿路成像复查无吻合口狭窄,肾积水和输尿管扩张均得到明显改善或消失,中度肾积水者2例,无明显肾积水者6例。术后排泄性膀胱尿道造影无1例发生膀胱输尿管反流。结论经腹腔膀胱内途径腹腔镜下输尿管膀胱再植术安全可靠,创伤小、并发症少、恢复快,抗反流效果好,有较好的临床应用及推广价值。[ Objective ] To evaluate the technical feasibility and clinical efficacy of transperitoneal laparoscopic ureteral reimplantation via vesical approach. [Methods] The 8 cases （3 males and 5 females） of ureterovesical obstruction （left, 7 and right, 1） who underwent transperitoueal laparoscopic ureteral reimplantation via vesical approach, 6 cases had been diagnosed to have simple congenital ureter outlet stricture, 1 ureteral stones patient was found ureter orifice stricture after ureteroscopic holmium laser hthotripsy, 1 with urinary TB had left ureter orifice stricture after right nephrectomy. B-ultrasound and IVU showed severe hydro-nephrosis in 5 cases, and moderate in 3. [Results] The operation was performed successful in all cases. The operative time was 90-140 min （mean, 112 mill） and the blood loss was 30-60 mL （mean, 40 mL）. The drainage tubes were removed after 1 -3 d without urine leakage, and the urinary catheters were removed 2 weeks after surgery. The mean hospital stay was 8d （range, 7-10 d）. The double-J stents were removed 2N3 months after operation. The patients were followed up for 3-12 months. B-ultrasound, IVU and MRU showed no anastomotic stricture and remission of hydro-nephrosis （moderate in 2 cases and resolution in 6）. Cystography showed no reflux in all cases during follow-up. [ Conclusions ] Transperitoneal laparoscopic ureteral reimplantation via Vesical Approach is a safe and effective procedure with minimal invasion,fewer complications, quicker recovery, better anti-reflux effect, and has better value for clinical application and popularization.

关 键 词：腹腔镜 输尿管下段狭窄 输尿管膀胱再植 

分 类 号：R693.2[医药卫生—泌尿科学]