老年患者经后腹腔途径腹腔镜下腔静脉后输尿管成形术

Transretroperitoneal laparoscopic treatment of circumcaval ureter in an aged patient

目的:探讨经后腹腔途径行腹腔镜输尿管端端吻合术治疗老年患者下腔静脉后输尿管畸形的方法与治疗效果。方法:应用腹腔镜经后腹腔途径游离右输尿管,于扩张输尿管下端离断输尿管,行输尿管端端吻合术,恢复右输尿管正常通道。结果:手术均获成功,下腔静脉等邻近器官未损伤,术中无明显出血,患者创伤小、康复快。术后复查示右肾及输尿管上段积水扩张显著减轻,肾功能良好。结论:下腔静脉后输尿管畸形也有在患者老年时开始出现临床症状的。经后腹腔途径行腹腔镜输尿管端端吻合术矫正下腔静脉后输尿管畸形是一种可行的手术方法。

Objective：To evaluate the effectiveness of transretroperitoneal laparoscopic ureteroureterostomy in the treatment of circumeaval ureter for an aged patient. Methods ：The operation was in a laparoscopic transretroperitoneal approach. After exposing the inferior vena cava and ureter, the retrocaval ureterie segment was safely incised. The ureter was then transpositioned to a normal anatomic position followed by laparoscopic intracorporeal uretero-ureteric anastomosis and ureteric stenting. Results：The operation was successful. There was no significant complication or bleeding during the operation. The patient recovered well after the operation. Ultrasound performed two months and four months after the operation showed normal ureteric course and only mild hydronephrosis. Conclusions： Patients with a circumcaval ureter can present no clinical symptoms until they are old. A transretroperitoneal laparoscopic transposition and ureteroureterostomy of a circumcaval ureter is feasible and technically safe with little bleeding and quick recovery.