单孔腹腔镜联合输尿管体外修剪技术在输尿管膀胱再植术中的应用

Laparo-endoscopic single-site surgery combined with extracorporeal ureteral trimming technique in ureteral bladder reimplantation

目的:探讨经脐单孔腹腔镜联合体外修剪技术治疗输尿管末段梗阻的可行性及术后疗效观察。方法:回顾性分析2020年3月至2023年3月南方医科大学第三附属医院收治的23例因输尿管末段梗阻行输尿管膀胱再植术患者的病例资料。术中均采用斜卧截石位,手术采用脐部约3 cm切口,放置四通道单孔穿刺套件,用于放置腹腔镜观察孔及操作孔,术中可将输尿管断端脱出至体外进行精细修剪,并在直视下置入双J管,记录相关手术指标、术后并发症、患者满意度等临床数据。结果:所有患者均顺利完成手术,无增加辅助孔或改开放手术。手术时间(128.48±47.85)min,术后住院时间为(9.61±7.29)d,术中不留置术腔引流管,无术后出血、吻合口瘘及腹腔感染等并发症,手术切口美观,患者满意度好。结论:在严格把握适应证的前提下,单孔腹腔镜联合体外修剪技术治疗输尿管末段梗阻是安全可行的,并且具有术后恢复快、美容效果好等优势,值得推广。

Objective:To explore the feasibility of transumbilical laparo-endoscopic single site surgery(LESS)combined with extracorporeal trimming technique in the treatment of distal ureteral obstruction.Methods:Case data of 23 patients admitted to the Third Affiliated Hospital of Southern Medical University from March 2020 to March 2023 who underwent ureteral reimplantation for ureteral end-stage obstruction were retrospectively analyzed.All of them were operated in the reclined lithotomy position,and the operation was performed with an umbilical incision of about 3 cm,placing a four-channel single-hole puncture kit for placing laparoscopic observation holes and operation holes,which allowed dislodging of ureteral severed ends outside the body for fine trimming,and placing a double Jtube under direct visualization,and recording the relevant surgical indexes,postoperative complications,patient satisfaction,and other clinical data.Results:All patients successfully completed the surgery without adding auxiliary holes or changing to open surgery.The operation time was(128.48±47.85)min,the postoperative hospitalization days was(9.61±7.29)d.No intraoperative luminal drainage tube was left in the operation,and there were no complications such as postoperative hemorrhage,anastomotic fistula,and abdominal infection;the surgical incision was beautiful,and the patient satisfaction was good.Conclusion:Under the premise of strictly grasping the indications,laparo-endoscopic single site surgery combined with extracorporeal trimming technique for the treatment of distal ureteral obstruction is safe and feasible,and has the advantages of fast postoperative recovery and good cosmetic effect,which is worthy of promotion.