腹腔镜改进气膀胱Cohen式抗反流再植术治疗成人膀胱输尿管反流(附5例报告)  

Laparoscopic Improved Inflators Cohen Transvesical Ureteral Reimplantation for Adult Vesicoureteral Reflux:a Report of 5 Cases

作　　者：王凯强 杨成林 王尉 曹智 张惠芬 张小明 肖远松 Wang Kaiqiang;Yang Chenglin;Wang Wei(不详;Department of Urology,General Hospital of Southern Theater Command,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院泌尿外科,广州510010 [2]广州中医药大学研究生院,广州510405

出　　处：《中国微创外科杂志》2023年第7期547-552,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：军队医学科技青年培育计划项目(21QNPY125);广东省自然科学基金项目(2020A1515010044);军队护理创新与培育项目(2021HL052);广州市科技计划项目(202002030030)。

摘　　要：目的探讨腹腔镜改进气膀胱Cohen式抗反流再植术治疗成人膀胱输尿管反流的安全性及有效性。方法2017年1月~2020年1月我们对5例成人膀胱输尿管反流(vesicoureteral reflux,VUR)行腹腔镜改进气膀胱Cohen式抗反流再植术。固定膀胱后建立气膀胱,置入trocar,无接触式游离患侧输尿管末端,建立三角区对侧黏膜下隧道,将游离的输尿管置入对侧黏膜下隧道并缝合固定,最后置入输尿管支架管及导尿管。结果5例手术均顺利完成,无中转开放手术。手术时间176~226 min,平均198.4 min;术中出血量80~100 ml,平均88 ml。术中无肠道损伤,无休克等并发症。均留置导尿管时间7 d。住院时间10~12 d,平均11 d。双J管留置时间28~56 d,平均42.2 d。术后均无输尿管梗阻,术后留置导尿管期间1例因泌尿系感染出现发热,抗感染治疗后恢复,其余4例未见明显不适。术后肾脏ECT:5例左肾肾小球滤过率(glomerular filtration rate,GFR)平均42.31 ml/min,右肾GFR平均41.19 ml/min。术后2周复查血肌酐60~104μmol/L,平均77.8μmol/L。术后6个月复查尿常规白细胞1.8~20.0/μL,平均11.42/μL。术后6个月随访,5例腰痛症状均消失,排泄性膀胱尿道造影(voiding cystourethrogram,VCUG)示双侧均未见VUR,均无输尿管梗阻。结论腹腔镜改进气膀胱Cohen式膀胱输尿管抗反流再植术治疗成人VUR安全有效。Objective To evaluate the efficacy and safety of laparoscopic improved inflators Cohen transvesical ureteral reimplantation in the treatment of adult vesicoureteral reflux(VUR).Methods From January 2017 to January 2020,we performed laparoscopic modified neobladder Cohen-style anti-reflux replantation in 5 adult patients with VUR.After immobilizing the bladder,a pneumatic bladder was established.A trocar was inserted into,and the distal end of the affected ureter was disconnected without contact.A submucosal tunnel was established on the opposite side of the triangle,and a free ureter was inserted into the contralateral submucosal tunnel and sutured for fixation.Finally,a ureteral stent and a catheter were inserted.Results The surgery was successfully operated in all the 5 cases.The operation time was 176-226 min,with an average of 198.4 min.Estimated intraoperative bleeding volume was 80-100 ml,with an average of 88 ml.There were no intraoperative intestinal injury and complications such as shock.The retention time of catheter was 7 d.The hospitalization time was 10-12 d,with an average of 11 d.The retention time of the double J tube was 28-56 d,with an average of 42.2 d.There was no ureteral obstruction after the operation.During the retention of catheter after the operation,one patient developed fever due to urinary system infection,and recovered after anti-infection treatment.The other four patients had no obvious discomfort.Postoperative renal ECT showed that the average glomerular filtration rate(GFR)of the left kidney in the 5 cases was 42.31 ml/min,and the average GFR of the right kidney was 41.19 ml/min.Two weeks after surgery,blood creatinine levels were re-examined as 60-104μmol/L,with an average of 77.8μmol/L.Six months after surgery,urine routine white blood cells were re-examined as 1.8-20.0/μL,with an average of 11.42/μL.During follow-ups for 6 months,the symptoms of low back pain in 5 cases disappeared,and voiding cystourethrogram(VCUG)showed no VUR on both sides and no ureteral obstruction.Con

关 键 词：气膀胱Cohen式抗反流再植术 膀胱输尿管反流 腹腔镜 

分 类 号：R726.9[医药卫生—儿科]