经腹膜及经后腹膜入路腹腔镜下治疗腔静脉后输尿管的疗效分析  

Transperitoneal and retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter

作　　者：纪长威[1] 张古田[1] 张士伟[1] 赵晓智[1] 连惠波[1] 李笑弓[1] 甘卫东[1] 郭宏骞[1] 

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,210008

出　　处：《中华外科杂志》2014年第8期580-583,共4页Chinese Journal of Surgery

摘　　要：目的 探讨经腹膜和经后腹膜入路腹腔镜下输尿管端端吻合术治疗腔静脉后输尿管的手术技术和临床效果.方法 回顾性分析2004年5月至2012年12月于南京大学医学院附属鼓楼医院接受腹腔镜输尿管端端吻合术治疗的18例腔静脉后输尿管患者临床资料,男性12例,女性6例,年龄17 -55岁,平均年龄（37±10）岁.8例为经腹膜入路（经腹膜组）,10例为经后腹膜入路（经后腹膜组）.组间数据的比较采用t检验.结果 18例腹腔镜手术均顺利完成.经腹膜组平均手术时间（85 ±20）min（60 - 130 min）,经后腹膜组平均手术时间（98±30）min（70 -180 min）,差异无统计学意义（t=1.03,P＞0.05）.两组术中出血量均＜50 ml,术后1-2d患者通气并恢复正常饮食,术后通气时间差异无统计学意义（t =0.16,P＞0.05）.无围手术期并发症发生,术后3个月至1年复查静脉肾盂造影或CT尿路成像,显示患侧输尿管引流良好,肾盂积水减轻.随访时间12- 115个月,平均（40±24）个月,随访期间无需行二次手术矫形治疗病例.结论 经腹膜入路和经后腹膜入路腹腔镜输尿管端端吻合术均是治疗腔静脉后输尿管的安全微创的手术方式,术者应根据自己的经验特长选择合适的腹腔镜入路.Objective To analyze the results of transperitoneal and retroperitoneal laparoscopic ureteroureterostomy procedure in the treatment of patients with retrocaval ureter.Methods From May 2004 to December 2012,18 patients including 12 male and 6 female patients were operated for retrocaval ureter,the average age was （37 ± 10） years （range 17-55 years）.Eight patients underwent transperitoneal laparoscopic ureteroureterostomy （transperitoneal laparoscopic group）,and the other 10 patients＇laparoscopic procedure were performed via retroperitoneal approach （retroperitoneal laparoscopic group）.These patients＇ records were retrospectively analyzed for perioperative characteristics,complications and follow-up results.A two-tailed Student＇s t-test was used to compare perioperative data between the two groups.Results Technical success was acquired in all 18 laparoscopic procedures.Mean operative time of transperitoneal and retroperitoneal laparoscopic group was （85 ± 20） minutes（60-130 minutes）and （98 ± 30） minutes （70-180 minutes）,respectively.There was no difference in operation time between the two groups （t =1.03,P ＞ 0.05）.The blood loss was less than 50 ml in all the patients.Comparison of anal exhaust time between the two groups showed no statistic difference （t =0.16,P ＞ 0.05）.No perioperative complication was observed.Intravenous pyelography or CT urography 3 months after the operation revealed a widely patent anastomosis with considerable improvement in hydronephrosis in all patients.There was no recurrence at a mean follow up of （40 ± 24）months （range 12-115 months）.Conclusion Both transperitoneal and retroperitoneal laparoscopic ureteroureterostomy are effective and minimally invasive surgical alternative for the management of retrocaval ureter.

关 键 词：腹腔镜检查 输尿管疾病 治疗结果 

分 类 号：R699.4[医药卫生—泌尿科学]