气膀胱腹腔镜Cohen输尿管种植术治疗输尿管末端狭窄  

Preliminary report and surgical techniques of pneumocystoscopic cohen ureter reimplantation for lower -ureteral stenosis

作　　者：谢国欧 何本林 皮硕煌[1,2] 杨军[1,2] 刘俊[1,2] 文小波[1,2] 黄海[3] 

机构地区：[1]湖南省石门县人民医院 [2]长沙医学院附属石门医院泌尿外科,415300 [3]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中华腔镜泌尿外科杂志（电子版）》2014年第5期43-45,共3页Chinese Journal of Endourology(Electronic Edition)

基　　金：农村信息直通车工程项目(2011A020600010);广东省自然科学基金资助项目(10151008901000070);国家自然科学基金资助项目(81101947)

摘　　要：目的 探讨应用气膀胱腹腔镜行Cohen输尿管种植术治疗输尿管末端狭窄的方法,并总结初步的手术技巧.方法 2009年6月至2012年6月,湖南省石门县人民医院应用气膀胱腹腔镜Cohen输尿管种植术治疗输尿管末端狭窄患者8例,年龄5～35岁,中位年龄12.5岁,其中男5例,女3例,病变位于左侧6例,右侧2例.术中在膀胱镜引导下于脐下膀胱顶置入5mm目镜鞘管并固定,建立CO2气膀胱,两侧放置5mm操作鞘管,沿患侧输尿管口环形剪开膀胱黏膜,沿着输尿管壁内段将输尿管下段游离,切除输尿管狭窄段,继续向上游离输尿管3～5 cm后拖入膀胱,于对侧输尿管上内侧做一个2～3 cm黏膜下隧道至患侧输尿管口处,将患侧输尿管经黏膜下隧道拖至对侧输尿管口上方,输尿管口与周围膀胱黏膜间断缝合,常规留置双J管.结果 8例手术均获得成功,无中转开放手术.手术时间115～197min,平均143min,8～10d拔除导尿管.术后随访5～10个月,无腰痛及尿路感染发生,超声检查肾积水及输尿管扩张程度减轻,膀胱尿路造影均未发现膀胱输尿管反流.结论 气膀胱腹腔镜Cohen输尿管种植术治疗输尿管末端狭窄是一种安全有效的手术方式.Objective To introduce the experiences and techniques of pneumocystoscopic Cohen ureter reimplantation for lower ureteral stenosis.Methods From June 2009 to June 2012,8 cases with lower ureter stenosis were treated with pneumocystoscopic Cohen ureter reimplantation.In all of these cases,5 patients were male,3 were female.Mean age was 12.5 years （5-35 years）.The number of patients with left -side lesions was 6,right-side lesions was 2.The laparoscopic procedure was preceded by distention of the bladder with saline and insertion of a 5-mm port over the bladder dome under cystoscopic guidance.The bladder was then insufflated with CO2 gas,the other two 5-mm working port were inserted to the lateral bladder wall on either side.A circumferential incision was made around the ureteral orifice,and then removed the stenostic segment.At least 3-5 cm ureter was pulled into the bladder.The ureter was dragged to the superior of contralateral ureter orifice through the submucosal tunnel,interrupted sutured the ureter orifice to the surround mucosa of bladder,indwelled the double J stent conventionally.Results The procedure was completed in all the 8 patients without conversion to open surgery.The mean operation time was 143 min（115-197 min）.The patients had the urinary catheter been removed in 8 to 10 days.The patients were followed up for 5 to 10 months,no back pain or urinary tract infection occurred,ultrasonography and cystography showed that the hydronephrosis or dilation of ureter were improved and no vesicouretral reflux were found.Conclusion The pneumocystoscopic Cohen ureter reimplantation is a safe and effective option for lower ureteral stenosis.

关 键 词：气膀胱 腹腔镜 输尿管种植 经膀胱 输尿管狭窄 

分 类 号：R699.4[医药卫生—泌尿科学]