腹腔镜下输尿管松解术在腹膜后纤维化治疗中的临床应用

Laparoscopic ureterolysis in the treatment of retroperitoneal fibrosis

目的:探讨腹腔镜下输尿管松解术在腹膜后纤维化治疗中的临床应用价值.方法:2009年1月～2012年1月,共对10例腹膜后纤维化患者实施腹腔镜下输尿管松解术,记录围手术期资料.术前对患侧输尿管留置双J管.手术取健侧30～60°斜卧位,沿Toldt线打开侧腹膜,将结肠翻下至中线,显露后腹腔,辨别输尿管近端及远端未被纤维斑块包绕的正常部分,钝性、锐性相结合游离输尿管并移至腹腔内,在其后方关闭后腹膜.结果:共10例患者,男9例,女1例,年龄50～66岁,BMI19.79～25.69 kg/m2.所有患者均顺利完成手术,平均手术时间185 min,平均术中出血量59.5 ml,术后平均肠功能恢复时间2.7d,无输血及中转开放手术病例,所有患者无严重并发症出现.结论:腹腔镜下输尿管松解术具有创伤小、恢复快,效果好,并发症少等特点,是治疗腹膜后纤维化安全、有效的手术方式.

Objective:To evaluate the clinical application value of laparoscopic ureterolysis in the treatment of retroperitoneal fibrosis.Methods:The perioperative data of 10patients with retroperitoneal fibrosis treated by laparoscopic ureterolysis in our department from Jan 2009to Jan 2012were reviewed.The double J stent was indwelled into the ipsilateral ureter before operation.The patient was placed to 30to 60degree slope contralateral decubitus,After opening the peritoneum along the Toldt line,the colon was pushed midline to expose the retroperitoneal,and identified the normal part of ureter which was not surrounded by fibrous tissue.The ureter was then dissected and moved intraperitoneally.Results:10patients(9males and 1female)with BMI ranged from 19.79-25.69kg/m2 were successfully operated.The average operative time was 185min,average blood loss was 59.5ml and average postoperative intestinal function recovery time was 2.7d.No transfusion was required and no serious complication was occurred in all the patients.Conclusions:Laparoscopic ureterolysis had the advantages of less invasive,rapid recovery, better effect and fewer complications.It is therefore a safe and effective surgical procedure in treating retroperitoneal fibrosis.