改良腹腔镜膀胱外输尿管再植术治疗原发性梗阻性巨输尿管  

Modified Laparoscopic Extravesical Ureteral Reimplantation for Primary Obstructive Megaureter

作　　者：董佳祺 陈洁珺 郭云飞[1] 黄立渠 Dong Jiaqi;Chen Jiejun;Guo Yunfei(Department of Urology,Children’s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院泌尿外科,南京210008

出　　处：《中国微创外科杂志》2024年第10期672-677,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：江苏省卫生健康委科研项目(M2021007);国家自然科学基金(82000643)。

摘　　要：目的探讨改良腹腔镜膀胱外输尿管再植术治疗原发性梗阻性巨输尿管的临床效果。方法回顾性分析2020年12月~2023年10月改良腹腔镜膀胱外输尿管再植术(Lich-Gregoir法)治疗原发性梗阻性巨输尿管11例资料。年龄7个月~10岁5个月,(57.6±41.9)月。术中从膀胱后壁纵向建立隧道,并将新隧道的腹侧端作为输尿管吻合口。结果11例腹腔镜操作均获成功,无术中并发症,无中转开腹。手术时间105~145 min,(125.5±13.9)min。11例随访4~25个月,平均16个月。均无排尿困难、尿路感染。术后3~6个月输尿管远端最大径和肾积水均较术前明显减轻[输尿管远端最大径从(23.0±10.0)mm缩小至(5.2±3.4)mm(P=0.000),肾集合系统最大分离值从(35.2±21.1)mm缩小至(11.6±6.9)mm(P=0.001)]。结论改良腹腔镜膀胱外输尿管再植术操作简单,可作为儿童原发性梗阻性巨输尿管治疗方案之一。Objective To investigate the clinical outcome of modified laparoscopic extravesical ureteral reimplantation for primary obstructive megaureter(POM).Methods A retrospective analysis was made on 11 cases of POM treated with modified laparoscopic extravesical ureteral reimplantation(Lich-Gregoir method)from December 2020 to October 2023.The patients were aged from 7 months to 10 years and 5 months old(mean,57.6±41.9 months).Intraoperatively,a tunnel was created longitudinally from the posterior bladder wall and the ventral end of the new tunnel was used as the ureteral anastomosis.Results All the 11 laparoscopic operations were successful with no intraoperative complications and no conversions to open surgery.The operation time was 105-145 min(mean,125.5±13.9 min).The 11 cases were followed up for 4-25 months(mean,16 months).None of them had difficulty in urination or urinary tract infection.The distal ureter maximum diameter and hydronephrosis were significantly reduced at 3-6 months after surgery than those before surgery[the distal ureter maximum diameter reduced from(23.0±10.0)mm to(5.2±3.4)mm(P=0.000),and the maximal separation value of the renal collecting system reduced from(35.2±21.1)mm to(11.6±6.9)mm(P=0.001)].Conclusion Modified laparoscopic extravesical ureteral reimplantation is easy to perform and can be one of the treatment options for primary obstructive megaureteropathy in children.

关 键 词：原发性梗阻性巨输尿管 改良术式 腹腔镜膀胱外输尿管再植术 

分 类 号：R726.9[医药卫生—儿科]