腹膜外腹腔镜膀胱外输尿管膀胱再植术的临床应用

Extraperitoneal Laparoscopic Extravesical Ureterovesical Reimplantation in 10 Patients

【目的】探讨经腹膜外径路腹腔镜下膀胱外输尿管膀胱再植术临床应用的可行性。【方法】应用腹膜外腹腔镜下膀胱外黏膜下隧道式抗反流输尿管膀胱再植术（Lich-Gregoir改良术）治疗10例输尿管出口梗阻患者，其中5例为单纯先天性输尿管末端狭窄；2例为巨输尿管症；3例为重复肾输尿管末端狭窄（2例为双侧性）。【结果】10例均获得成功，无中转开放手术。单侧手术时间（107±22）min，出血量（49±16）mL，住院时间（5．8±1．1）d，术后无一例发生并发症。随访3～12个月，B超、静脉肾孟造影和（或）磁共振尿路成像显示肾积水或输尿管扩张明显好转或消失，排泄性膀胱尿道造影观察无一例发生膀胱输尿管反流。【结论】腹膜外径路腹腔镜下膀胱外黏膜下隧道式抗反流输尿管膀胱再植术方法简单、创伤小、并发症少、恢复快、抗反流效果好，值得临床推广。

[Objective]To evaluate the clinical feasibility of the technique of trans-extraperitoneal laparoscopic extravesical ureterovesical reimplantation. [Methods]From September 2005 to March 2007, 10 cases of ureterovesical orifice stenosis were treated with extravesical reimplantation under submucosal tunnel （modified Lich-Gregoir technique） via a trans-extraperitoneal laparoscopic approach for vesicoureteral reflux. There were 4 males and 6 females. Of them, 3 patients had double nephroureter with outlet stenosis （unilateral in 1 case and bilateral in 2 cases）, 5 cases with simple congenital ureter outlet stricture and 2 cases with megaureter. [ResuhslAll procedures were successfully completed laparoscopically. The unilateral mean surgical time was （107±22） minutes, blood loss （49± 16） ml, hospital stay （5.8± 1. 1） days. No complication was found in postoperation. At follow-up ranging 3 to 12 months, B uhrasonography and intravenous urogram or MRU showed that hydronephrosis or dilatation of ureter were improved in different degree or disappeared. Voiding cystourethrography did not demonstrate any reflux. [Conclusion]Extrapei＇itoneal laparoscopic ureterovesical reimplantation under submucosal tunnel is a simple, safe, minimally invasive and effective approach for ureterovesical orifice stenosis.