成人先天性巨输尿管症的临床治疗

The Clinical treatments of congenital obstructive megaureter

目的探讨成人先天性巨输尿管症的临床治疗方法，评估开放手术与腹腔镜手术的临床治疗效果。方法成人先天性巨输尿管症24例，13例行开放输尿管中下段裁剪输尿管膀胱再植术，11例行腹腔镜输尿管成形术。结果开放手术时间2．0～3．0h，出血60—120ml．住院时间8～12天。腹腔镜手术时间2．0～4．0h，出血20～40ml．住院时间5～8天。两组均于术后3个月拔除双J管，无腰痛和发热。随访3个月-5年输尿管均无梗阻。结论腹腔镜输尿管成形术出血少，损伤小，住院时间短，效果好。

Objectives To discuss the methods of retroperitoneal laparoscopy for ureteroplasty , uretervesicostomy in treating congenital obstractive megaureter（CM）. Methods We performed 24 cases of CM （ including 13 cases of open operations and 11 cases of retroperitoneal laparuscopy operations）. Results Mean open operation time was 150 minutes （ range from 120 to 180）. Mean blood loss was dotal（ range from 60 to120） ,and 8 - 12days in hospital. Mean operation time of the retropefitoneal laparoscopy was 180 minutes （range from 120 to 240 ）. Mean blood loss was 30ml （ range from 20 to 40）, and 5 - 8 days in hospital. Double J was removed in 3 months after opera- tions without complications. At a mean follow up of 12months（ from 3 to 60 ）, obstructions were diminished. Conclusions Retroperitoneal laparoscopy is a feasible method for treatment of CM for its minimum invasion and lessblood loss, and shows better outcome than open operatin.