腹膜后腹腔镜手术治疗下腔静脉后输尿管（附14例报告）

The treatment of retrocaval ureter by retroperitoneal laparoscope （report of 14 cases）

目的探讨腹膜后腹腔镜手术治疗下腔静脉后输尿管的手术方法和治疗效果。方法回顾性分析2005年10月～2010年10月14例下腔静脉后输尿管患者的临床资料，术前均经B超、尿路X线平片（KUB）、静脉尿路造影（IVU）和多层螺旋CT三维尿路成像（MSCTU）检查而明确诊断，其中3例合并右输尿管结石。采用腹腔镜技术经腹膜后途径施行下腔静脉后输尿管离断复位矫正术。合并输尿管结石的患者予同时取出结石。术后6个月复查1VU，以后每年复查B超或IVU。结果14例均在后腹腔镜下顺利完成手术，无中转开放。手术时间95min-210rain，平均（135±58）min。术中出血量20ml～90ml，平均（35±48）ml。住院时间6d-8d，平均7天。无切口感染、漏尿。术后6w-8w拔除双J管。随访6个月～36个月，平均17．5个月，术后6个月复查IVU显示输尿管引流通畅，无吻合口狭窄；术前腰部酸痛、血尿症状均消失，B超检查显示右肾积水和输尿管上段扩张明显减轻。结论腹膜后腹腔镜手术治疗下腔静脉后输尿管具有与开放手术同样的效果，且手术创伤性小，恢复快，值得推广。

Objectives To explore the method and the effect of treatment of retrocaval ureter by retroperito- Meal laparoscope. Methods 14 patients with retrocaval ureter were diagnosed by B -ultrasound, IVU and multi- layer scan CT urography with 3D display （ MSCTU）, and underwent laparoscopic reteroureterostomy. Ureteric calculi were found in three cases. Retroperitoneal approach was used in all cases. Firstly, ureteric calculi were removed, and the retrocava segment of ureter was transected and repositioned and transposed anterior to the inferior vena cava, the ureteroureteral anastomosis was completed. Results All operations were successful. No conversion to open surgery was needed and no major complications developed. The mean surgical time was （ 135 ~ 58 ） minutes （ range 95 to 210 minutes）. The volume of hemorrhage was （35 ±48） ml （range 20 to 90 ml）. Patients were discharged home at a mean of 7 days （range 6 to 8 days）. The stent was removed 6 weeks to 8 weeks later. With a mean follow - up of 17.5 months （range 6 to 36 months） ,excretory urogram 6 months after laparoseopie repair revealed a widely patent anastomosis with considerable improvement in hydronephrosis in all patients. Conclusions The treatment of retrocaval ureter by retroperitoneal laparoscope is a safe, effective and minimally invasive procedure.