经腹腹腔镜手术治疗下段输尿管良性梗阻(附11例报告)  

Transabdominal laparoscopic treatment of lower ureteral benign obstruction: with a report of 11 cases

作　　者：李威武[1,2] 李爱华[1,2] 张峰[1,2] 陆鸿海[1,2] 刘思宽[1,2] 王晖[1,2] 张炳辉[1,2] 方炜[1,2] 

机构地区：[1]同济大学附属杨浦医院 [2]上海市杨浦区中心医院,上海200090

出　　处：《腹腔镜外科杂志》2013年第12期953-955,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜手术治疗下段输尿管良性梗阻的方法及临床疗效。方法:回顾分析为11例下段输尿管良性梗阻患者行腹腔镜手术的临床资料。术前患者均经影像学检查,6例曾行输尿管镜检及气压弹道或钬激光碎石术,其中1例3次,3例2次,2例1次。6例曾行输尿管镜检无法通过,取活检4例,病理报告为慢性炎症及纤维组织增生。结果:11例手术均获成功,手术时间65～156 min,平均(99.27±31.76)min;术中出血量30～110 ml,平均(63.82±24.37)ml;术后胃肠功能恢复时间1～3 d,平均(1.64±0.81)d;术后下床活动时间2～5 d,平均(3.64±1.04)d;术后住院5～10 d,平均(7.09±1.58)d。术后随访6～48个月,11例患者输尿管梗阻解除后肾功能恢复良好,10例吻合口通畅,1例略狭窄,但造影剂可通过。结论:经腹腹腔镜手术治疗下段输尿管良性梗阻疗效确切,患者创伤小、康复快,术者熟练掌握腹腔镜操作技巧,熟悉解剖结构,可作为治疗下段输尿管良性梗阻的较佳选择。Objective：To study the method and the curative effect of laparoscopic treatment of lower ureteral benign obstruction. Methods：The clinical data of 11 patients who underwent transabdominal laparoscopic treatment of lower ureteral benign obstruction were retrospectively analyzed. The patients were diagnosed by imaging examination, a total of 6 patients underwent ureteroscopy and were given pneumatic ballistic or hohnium laser lithotripsy,including 1 case for 3 times,3 cases for 2 times,2 cases for 1 time. 6 cases failed to undergo ureteroscopy. Biopsy was performed in 4 patients whose pathological reports were chronic inflammation and fibrous tis- sue proliferation. All 11 cases underwent transperitoneal laparoscopic resection of stenotic segment and end-to-end anastomosis. Re- suits ： All operations were successful, the operation time was 65-156 min, the mean was （99.27 ± 31.76） min, blood loss was 30-110 ml with the average of （63.82 ±24.37 ） ml, postoperative gastrointestinal function recovery time was （ 1.64 ±0.81 ） d （ 1-3 d）, postoperative ambulation time was （3.64 ±1.04） d （2 to 5 d） ,postoperative hospital stay was （7.09 ±1.58） d （5 to 10 d）. During the follow-up of 6-48 months,the patients＇ renal function after surgery recovered well. 10 cases of anastomotic stoma were unobstructed, the anastomosis of 1 case was slightly narrow,but the contrast agent could pass through it. Conclusions：The therapeutic effect of transab- dominal laparoscopic treatment of lower ureteral benign obstruction is exact, this procedure has fewer traumas, quicker recovery, it could be the better choice for the treatment of lower ureteral benign obstruction,if the surgeon is skilled at laparoscopic operation, and is familiar with the anatomic structure.

关 键 词：输尿管梗阻 腹腔镜检查 病例报告 治疗结果 

分 类 号：R699[医药卫生—泌尿科学]