后腹腔镜输尿管成形术治疗下腔静脉后输尿管的体会  

Retroperitoneal laparoscopic ureteroplasty for patients with retrocaval ureter

作　　者：叶剑青[1] 张东旭[1] 李勋钢[1] 崔心刚[1] 陈杰[1] 王军凯[1] 李尧[1] 陈露[1] 徐丹枫[1] 

机构地区：[1]第二军医大学附属长征医院全军泌尿外科中心,上海200003

出　　处：《腹腔镜外科杂志》2012年第4期271-273,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨后腹腔镜输尿管成形术治疗下腔静脉后输尿管的临床经验及疗效。方法:回顾分析2004年1月至2011年10月13例下腔静脉后输尿管患者的临床资料,其中男10例,女3例;平均(33.2±6.8)岁;8例有症状,体检发现5例;13例患者均行后腹腔镜输尿管成形术。结果:13例手术均获成功,无一例中转开放手术。平均手术时间、输尿管端端吻合时间分别为(110±21.1)min、(30.2±11.4)min,术中出血量平均(24.3±5.6)ml,术后平均负压引流(4.0±1.2)d,平均留置导尿管(5.9±2.8)d,平均住院(5.3±1.4)d,术后1个月拔除双J管。术后平均随访(30.2±11.3)个月,13例患者肾及输尿管上段扩张积水显著减轻,吻合口无狭窄,8例患者术前不适症状消失。结论:后腹腔镜输尿管成形术治疗下腔静脉后输尿管安全、有效,具有患者创伤小、康复快等优点,可作为治疗下腔静脉后输尿管的首选方法。但远期疗效尚需大样本对照研究及长期随访观察。Objective： To study the clinical experiences and effects of retroperitoneal laparoscopic ureteroplasty for patients with retrocaval ureter. Methods ：The clinical data of 13 cases （10 males and 3 females） with retrocaval ureter from Jan. 2004 to Oct. 2011 were analyzed retrospectively. Mean age was （33.2 ±6.8 ） years. 8 patients had symptoms, while other 5 patients were found by physical examination. All of the 13 patients received retroperitoneal laparoscopic ureteroplasty. Results：Thirteen cases were operated successfully without conversion to open surgery nor severe perioperative complications. The mean operation time and ureteral anastomosis time was （ 110±21.1 ） min and （30.2±11.4） min, and mean blood loss was （24.3±5.6） ml. The mean closed suction drainage and re- tained Foley catheter duration was （4.0±1.2） days and （ 5.9±2.8 ） days, and mean postoperative hospital stay was （ 5.3 ± 1.4） days. The double-pigtail ureteral stent was removed 1 month afte the operation. In a mean follow up for （30.2±11.3 ） months, 13 patients received a remarkable improvement in the kidney and upper ureteral obstruction without anastomotic stenosis, preoperative symp- toms of 8 patients disappeared. Conclusions ： Retroperitoneal laparoscopic ureteroplasty in patients with retrocaval ureter is safe and effective with less trauma and faster recovery,it can be used as first choice for the treatment of retrocaval ureter. But the long-term thera- peutic effect still need case-control study with large sample and long term follow-up.

关 键 词：输尿管成形术 下腔静脉后输尿管 腹腔镜检查 腹膜后途径 预后 

分 类 号：R699[医药卫生—泌尿科学]