体外修剪输尿管在经腹腔镜离断式成人输尿管狭窄手术中的应用  

Application of External Ureteral Clipping in Laparoscopic Dissociation of Adult Ureteral StrictureOperation

作　　者：丛桂成[1] 崔小健[1] 陈延航 姜良真 姚庆祥[1] CONG Gui-cheng;CUI Xiao-jian;CHEN Yan-hang(Department of Urological Surgery,Tianjin Teda Hospital,Tianjin(300457),China)

机构地区：[1]天津市泰达医院泌尿外科,天津300457

出　　处：《中国中西医结合外科杂志》2020年第2期319-322,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:回顾我院在经腹腔镜下离断式输尿管狭窄手术中近端输尿管体外修剪的方法,分析该方法的可行性及安全性。方法:总结我院自2012年3月—2018年10月行经腹腹腔镜下输尿管狭窄手术患者30例,其中10例采用近端输尿管在体外修剪方式处理,20例采用传统方法体内修剪后完成手术治疗。结果:30例手术均顺利完成,体外组均成功截取病变段,输尿管保留完好,无中转开放手术,平均手术时间(107.9±13.5)min,平均出血量(48.7±3.8)mL,平均住院时间(7.8±1.3)d,短于传统组的(148.0±25.3)min和(9.1±1.5)d,差异有统计学意义。无吻合口瘘,随诊0.5~3年未见吻合口狭窄,肾积水减轻,中度积水2例、轻度积水6例、积水消失2例,肾功能显像均改善,输尿管造影显影良好7例,显影改善3例。结论:在不同的患者行输尿管上段狭窄或肾盂成形术手术中,近端输尿管修剪如在腔镜下难以准确判断病变位置、长度等,可在体外进行修剪,修剪满意后再行还纳继续手术,这样可降低腔内手术难度及准确感知病变情况,为该类手术提供一种安全可行的方法。Objective To review the method of proximal ureteral external pruning in laparoscopic dissociated ureteral stricture in our hospital and to analyze the feasibility and safety of this method.Methods A total of 10 patients underwent transabdominal laparoscopic ureteral stricture surgery in our hospital from March 2012 to October 2018,all of whom were treated by external pruning after proximal ureter was pulled out along the puncture device.Results Under this method,30 cases were successfully completed surgery,successfully intercepted lesions.Their ureters were keep in good condition,with no open surgery.The average operation time was(107.9±13.5)min,the average blood loss was(48.7±3.8)mL and the average length of hospital stay was(7.8±1.3)d,with no anastomotic fistula and no anastomotic stricturet for about 0.5 to 3 years of followup.Referring kidney seeper,moderate water was in 2 cases,mild water in 6 cases and 2 cases disappeared.7 cases of renal scintigraphy were improved,7 cases of ureteral contrast were enhanced and 3 cases were improved.Conclusion In operations of different patients with ureteral stricture or pyeloplasty,the proximal ureteral clip as in the laparoscopy is difficult to accurately determine the lesion location,length and etc.Therefore,they can be cut in vitro.After pruning satisfactory,they were continuously accepted operation,which can reduce the difficulty of cavity operation and accurately detect the pathological changes.It could provide a safe and feasible method for this kind of operation.

关 键 词：肾盂成形术 输尿管狭窄 腹腔镜手术 

分 类 号：R693.2[医药卫生—泌尿科学]