腹腔镜自体舌黏膜补片输尿管成形术治疗复杂输尿管狭窄的疗效分析  

Analysis of Effect of Laparoscopic Autologous Lingual Mucosal Graft Ureteroplasty for the Treatment of Complex Ureteral Stricture

作　　者：方露[1] 杨超[1] 王琦[1] 彭龙飞 张涛[1] 于德新[1] 王毅[1] Fang Lu;Yang Chao;Wang Qi(Department of Urology,Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院泌尿外科,合肥230601

出　　处：《中国微创外科杂志》2025年第4期233-237,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜自体舌黏膜补片输尿管成形术治疗复杂输尿管狭窄的安全性和有效性。方法2021年5月~2023年10月我科采用腹腔镜下自体舌黏膜补片输尿管成形术治疗10例输尿管狭窄,术中游离并纵行切开狭窄段输尿管,根据狭窄情况切取长2.0~7.0 cm、宽1.0~1.5 cm舌黏膜,裁剪修整后与狭窄段输尿管确切吻合,放置双J管1根。结果10例手术均顺利完成,无中转开放手术,术中无严重并发症发生。手术时间(237.0±67.1)min,术中出血量25.0(20.0,30.0)ml,术后术区引流管留置时间4.0(4.0,4.8)d,导尿管留置时间6.5(6.0,9.5)d,术后住院时间6.0(6.0,6.8)d。术后1周患者发音吐字清晰,进食无障碍。术后1~2个月拔除双J管。10例术后随访(12.3±7.1)月,1例患侧肾积水加重,再次行腹腔镜输尿管狭窄段切除+端端吻合术,其余9例患侧肾积水较前明显改善,肾盂分离(2.9±1.2)cm(t=8.022,P=0.000),肾功能较前好转,血肌酐(74.3±25.5)μmol/L,与术前(80.1±26.6)μmol/L比较差异无显著性(t=1.825,P=0.105)。结论腹腔镜自体舌黏膜补片输尿管成形术治疗复杂输尿管狭窄,具有恢复快、效果可靠等优点,是一项安全可行的输尿管重建技术。Objective To investigate the safety and validity of laparoscopic autologous lingual mucosal graft ureteroplasty for the treatment of complex ureteral stricture.Methods A total of 10 patients who underwent laparoscopic autologous lingual mucosal graft ureteroplasty in our hospital from May 2021 to October 2023 were retrospectively analyzed.During the operation,the narrow segment was longitudinally dissected,and according to the length of stricture,the lingual mucosal graft of 2.0-7.0 cm in length and 1.0-1.5 cm in width was harvested and precisely anastomosed with the stenosed ureter,followed by double J stent placement.Results All the operations were successfully completed with no conversion to open surgery or intraoperative complications.The operative duration was(237.0±67.1)min,the estimated blood loss was 25.0(20.0,30.0)ml,the duration of drainage tube indwelling was 4.0(4.0,4.8)d,the duration of urinary catheter indwelling was 6.5(6.0,9.5)d,and the duration of postoperative hospitalization was 6.0(6.0,6.8)d.All the patients’oral function recovered well within 1 week,and the double J stent was removed 1-2 months after the surgery.The mean follow-up time was(12.3±7.1)months.One case of aggravated hydronephrosis on the affected side underwent a second laparoscopic ureteral stricture resection and end-to-end anastomosis.The remaining 9 cases showed significant improvement in hydronephrosis on the affected side,with improved renal pelvis separation[(2.9±1.2)cm,t=8.022,P=0.000]and renal function compared to before surgery.Their blood creatinine was(74.3±25.5)μmol/L,with no significant difference compared to preoperation[(80.1±26.6)μmol/L,t=1.825,P=0.105].Conclusion Laparoscopic autologous lingual mucosal graft ureteroplasty for the treatment of complex ureteral stricture is a safe and feasible ureteral reconstruction technique with advantages of quick recovery and reliable outcomes.

关 键 词：输尿管狭窄 舌黏膜补片 腹腔镜手术 输尿管重建术 

分 类 号：R6[医药卫生—外科学]