腔静脉后输尿管三种手术方式的比较

Laparoscopic and Retroperitoneal Laparoscopic Ureteroureterostomy as Compared with Open Ureteroureterostomy for Retrocaval Ureter

目的:探讨腔静脉后输尿管的最佳治疗方式。方法:回顾性分析21例腔静脉后输尿管患者的治疗方法:14例行传统开放手术,其中1例行右肾切除术;3例行后腹腔镜下输尿管复位矫形术;4例行经腹腔手术,其中3例行腹腔镜下输尿管复位矫形术,1例行腹腔镜辅助下肾盂癌根治术。结果:21例手术均获成功。输尿管复位矫形术的开放组、后腹腔镜组和腹腔镜组平均手术时间分别为1.5 h、3.6 h和2.1 h;术中出血量分别为150ml、80 ml和70 ml;平均术后住院时间分别为7.5天、5天和6天。未出现围术期并发症。术后4～6周拔除双J管。随访6个月～4年,B超和(或)IVP复查无吻合口狭窄,输尿管梗阻均明显缓解。16例术前有右腰酸胀不适感症状者完全缓解。结论:采用腹腔镜下输尿管复位矫形术治疗腔静脉后输尿管应成为临床首选方式。经腹腹腔镜较后腹腔镜在腔静脉后输尿管段粘连严重的治疗和手术视野方面有一定优势。

Objective：To evaluate and compare laparoscopic and retroperitoneal laparoscopic ureteroureterostomy with open method for retrocaval ureter. Methods： Three different operation methods of 22 cases with retrocacal ureter were retrospectively analyzed. 14 patients underwent traditional open surgery, one for right nephrectomy; 3 patients underwent retroperitoneal laparoscopie ureteroureterostomy; transperitoneal laparoscopy was performed for 4 patients, in which 3 of laparoscopic ureteroureterostomy and one of laparoscopic radical nephrouretereetomy for complicated with pyelo carcinoma. Results： All the operation were successful. The operating time was 1.5 h. 3.6 h and 2.1 h for open, retroperitoneal laparoscopic and transperitoneal laparoscopic ureteroureterostomy respectively. The average bleeding volume during operation was 150 ml, 80 ml, and 70 ml respectively, and the postoperation hospitalization being 7.5 days, 5 days, and 6 days respectively. No perioperation complications oc curred. All patients received uneventful recovery. Follow up 6 months to 4 years, remarkable improvement in the ureteral obstruction was observed and no anastomotic stenosis. 16 cases of preoperative right waist sour bloated discomfort completely catabatic symptoms. Conclusions：The laparoscopic ureteroureterostomy should be considered to be first-line treatment for retrocaval urter comparable to that of traditional open surgery. The treatment of severe adhesion between caval vein and ureter in transperitoneal laparoscopic ureteroureterostomy were superior to those in retroperitoneal laparoscopic ureteroureterostomy.