腹腔镜下巨输尿管成型2种手术方法的疗效比较  

Comparison of two surgical methods for laparoscopic megaureteroplasty

作　　者：尹焯[1] 杨金瑞[1] 王荫槐[1] YIN Zhuo;YANG Jinrui;WANG Yinhuai(Department of Urology,the Second XiangYa Hospital of Central South University,Changsha,410011,China)

机构地区：[1]中南大学湘雅二医院泌尿外科,长沙410011

出　　处：《临床泌尿外科杂志》2020年第8期638-641,共4页Journal of Clinical Urology

摘　　要：目的:研究腹腔镜下巨输尿管裁剪或折叠后膀胱再植治疗梗阻性巨输尿管症的效果。方法:纳入18例梗阻性巨输尿管症患儿,年龄12~21岁,采用腹腔镜下巨输尿管成型后膀胱再植。巨输尿管成型采用2种不同手术方法,一组采用裁剪法,一组采用折叠法。术后随访尿常规、B超、CT、排尿期尿路造影、肾动态显像。比较两组患者术前的基线特征,围手术期各项指标和术后随访的结果。结果:18例患者手术均获成功,平均手术时间(175±26.3)min,平均失血量(39.7±15.6)mL,术后18例患者下腹疼痛症状消失,泌尿系感染纠正,患侧肾脏排泄梗阻率由轻度或中度排泄受阻恢复为正常。两组患者的年龄、男女性别比、BMI、确诊年龄比较差异无统计学意义。两组的手术成功率比较差异亦无统计学意义。结论:腹腔镜下巨输尿管成型后再植是治疗原发梗阻性巨输尿管症的一种有效的微创治疗手段。体外巨输尿管成型效果好,手术时间短。裁剪法和折叠法在术后输尿管狭窄和膀胱输尿管反流方面无显著差异。Objective:To study the effect of laparoscopic ureteroneocystostomy after ureteral tailing or plication in the treatment of obstructive megaureter.Method:Eighteen patients were involved in this study,who aged 12-21 years.All of them were treated with laparoscopic ureteral reimplantation with tailing or plication.They were divided into two groups according to received ureteral tailing or plication.All patients were followed up for urine analysis,B-mode ultrasonography,CT,VCUG and nuclear medicine.Result:All of the surgeries were successfully performed.The average operation time was(175±26.3)minutes and the average blood loss was(39.7±15.6)mL.The symptoms of lower abdominal pain disappeared after operation.Urinary infection was corrected.The rate of renal obstruction on the affected side was recovered from mild or moderate obstruction to normal.There were no significant differences in age,sex ratio,body mass index and age when diagnosis was made between two groups.There was no significant difference in the success rate between the two groups.Conclusion:Laparoscopic megaureteroplasty followed by replantation is an effective minimally invasive treatment for primary obstructive megaureter.Extracorporeal megaureteroplasty is effective and the operation time is significantly shortened.There was no significant difference between two methods(tailoring and plication)in the occur rate of ureteral stricture and reflux after operation.

关 键 词：腹腔镜 巨输尿管 输尿管裁剪 输尿管折叠 输尿管再植 

分 类 号：R693[医药卫生—泌尿科学]