腹腔镜治疗管外压迫致输尿管梗阻40例

Laparascopic treatments of exogenous obstructive ureters in 40 cases

目的探讨腹腔镜下输尿管松解和/或吻合术治疗管外压迫致输尿管梗阻性疾病的效果。方法该组40例,平均48.6岁;单侧32例,双侧8例。B超检查均有患侧肾输尿管扩张、积水,其中轻、中、重度肾积水分别为5、23和12例。手术经腹腔路径24例,腹膜后途径16例,于腹腔镜下予松解和/或切除病变段后行输尿管-输尿管或输尿管-膀胱吻合术治疗。结果40例手术均获成功,平均手术时间110.5min(75～175min),平均术中出血125.5m(L80～250mL),均无输血,术后3d起均无明显漏尿。平均随访16个月(3￣72个月)。30例行IVU、B超复查患肾分泌恢复正常;10例肾积水明显减轻,肾功能改善;吻合口无狭窄。结论有熟练操作经验的腹腔镜下松解和/或吻合术治疗管外压迫致输尿管梗阻性疾病,初步随访效果良好,有微创优势和实用价值。

[Objective] To evaluate the experiences and efficacy of treatments of exogenous obstructive ureters via laparascopy. [Methods] This series included 40 cases. Their mean age was 48.6 years. Thirty-two cases had obstruction on single side and 8 on both sides. All the 40 cases had distension in the upper ureters and hydronephrosis （5 in light, 23 in moderate, and 12 in severe hydronephrosis） by examination of B-ultrasonogrphy. The patients were underwent relief of ureter obstruction and uretero-ureter or uretero-bladder anastomosis by laparoscopy via transperitoneal pathway in 24 cases and extraperitoneal pathway in 16 cases. [Results] All the operation were successful. Mean operating time was 110.5 min（75-175 min）. Average blood loss was 125.5 mL （80 - 250 mL）. No blood transfusion was needed. No urine-leak had happened after 3 days. The renal function was recovery in 30 cases by examination of IVU and B-ultrasonography in the average follow-up time of 16 months （3-72 m）. The other 10 cases had improvement in the hydronephrosis. No stricture was recorded in the anastomotic stoma. [Conclusions] With skillful experience, laparascopic treatments of exogenous obstructive ureters is an effective, practical, and minimally invasive method.