气膀胱腹腔镜在膀胱输尿管连接处狭窄性畸形中的临床应用

The clinical application of pneumocystoscopic Cohen ureter reimplantation for congenital malformation of vesicoureteral junction obstruction in children

目的探讨气膀胱腹腔镜下输尿管再植术治疗膀胱输尿管连接处狭窄性畸形的手术效果。方法45例膀胱输尿管连接处梗阻患儿共61根输尿管均采用气膀胱腹腔镜下Cohen再植术，男26例，女19例。12根输尿管术中裁剪，9根输尿管术后留置双J管。所有病例术后均留置导尿管。结果2例中转开放手术，其余都在气膀胱下顺利完成。手术时间单侧平均为3．5h（2~8h），重肾输尿管平均为3．7h（3．5～4．5h），双侧平均为5．4h（3．5～9h）。术后导尿管留置平均6．7d（4～13d），静脉使用抗生素平均6．2d（4～13d），术后住院平均8．3d（5～14d）出院。35例（77．8％）48侧术后获得B超随访，随访时间为1～67个月，平均19．3个月。B超显示绝大部分肾盂宽度及输尿管扩张睛况较术前明显好转。1例（2．2%）术后半年因泌尿系感染检查发现输尿管扩张明显，再次手术后好转。9例（20％）术后进行DTPA肾动态显像，分肾功能较术前增高或维持原状。14例（31．1％）22侧行MCU检查，3例出现术后反流，1例出现对侧反流。结论气膀胱腹腔镜手术在治疗膀胱输尿管连接处狭窄性畸形方法上可行，手术成功率较高，随访肾盂及输尿管扩张情况明显好转，膀胱输尿管连接处梗阻解除。

Objective To evaluate the safety and efficacy of pneumocystoscopic Cohen ureter re- implantation for congenital malformation of vesicoureteral junction obstruction in children. Methods A total of 45 children, including 26 males and 19 females, were diagnosed with vesicoureteral junction obstruction and recruited in this study. Of these patients, 61 ureters were performed pneumocysto- scopic cohen ureter reimplantatior~ Twelve ureters were trimmed during surgery. Nine ureters were inserted with Double-J stents. Foley catheters were applied on all patients after surgery. Results The procedure was completed in all but 2 were converted to open operation. The mean operation time was 3.5 hours （range, 2 - 8 hours） for the patients with unilateral malformation, 3.7 hours （range, 3.5 - 4. 5 hours） for duplicated ureter , and 5.4 hours （range, 3.5 - 9 hours） for bilateral malformation. The mean preservation period of urethral catheter was 6. 7 days（range, 3 - 14 days）. Antibiotics was administered for a mean duration of 6. 2 days after operation （range, 3 - 14 days）. The mean postop- erative hospital stay was 8. 3 days （range, 5 - 14 days）. Forty-eight ureters of the 35 patients were followed up for 1 to 67 months （mean, 19. 3 months） after discharge. Ultrasonography found most patients＂ dilated urethral and renal pelvis was improved after surgery. One patient＇s bilateral ureters were still obviously dilated at 6 months after the surgery due to lower urinary tract infection, and the patient was performed a second ureter reimplantation and cured afterwards. DTPA of 9 patients were followed up, and suggested these patients＂ spilt renal function got improved or unchanged. MCU of the 14 patients found postoperative urethral reflux on 3 patients and eontralateral reflux on 1. Conclusions Pneumovesical Cohen ureteral reimplantation was safe and effective for vesicoureteral junction ob- struction in children.