腹膜外腹腔镜膀胱外输尿管膀胱再植术(附10例报告)

Extraperitoneal Laparoscopic Extravesical Ureterovesical Reimplantation(a Report of 10 Cases)

目的：探讨经腹膜外径路腹腔镜下行膀胱外输尿管膀胱再植术的临床应用可行性。方法：2005年9月--2007年3月用腹膜外腹腔镜下膀胱外黏膜下隧道式抗返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（男性4例，女性6例）。5例为单纯先天性输尿管末端狭窄；2例为巨输尿管症；3侧为重复肾输尿管末端狭窄，其中2侧为双侧性。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、静脉肾盂造影和（或）磁共振尿路成像显示肾积水或输尿管扩张有不同程度好转，排泄性膀胱尿道造影示无一例发生膀胱输尿管返流。结论：腹膜外径路腹腔镜下行膀胱外黏膜下隧道式抗返流输尿管膀胱再植术的方法简单、创伤小、并发症少、恢复快、抗返流效果好，值得临床推广应用。

Objective： To evaluate the clinical application feasibility 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. Among them, 3 patients had a double nephroureteral outlet stenosis （1 case with unilateral and 2 cases with bilateral）, 5 cases with simple congenital ureter outlet stricture and 2 cases with megaureter. Results： All procedures were successfully completed laparoscopically. The unilateral mean surgical time was （107±22） minutes, blood loss was （49±16） mL, hospital stay was （5.8±1.1 ） days. No complication was found 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： Extraperitoneal laparoscopic ureterovesical reimplantation under submucosal tunnel is a simple, safe, minimally invasive and effective approach for ureterovesical orifice stenosis.