后腹腔镜输尿管成型术治疗腔静脉后输尿管(附视频)

Retro-laparoscopic ureteroplasty for retrocaval ureter: Report of 3 cases

目的探讨经腹膜后途径行腹腔镜输尿管成型术治疗腔静脉后输尿管(RCU)的临床经验与疗效。方法 3例腔静脉后输尿管患者术前均接受静脉肾盂造影以及CT尿路造影检查确诊。全部患者均在全身麻醉下经后腹腔镜行输尿管离断成型手术,其中2例手术切除腔静脉后段输尿管,1例保留腔静脉后段输尿管。将输尿管离断后置于腔静脉前方重新吻合,连续无张力端端吻合,并留置双J管。结果手术均成功,无中转开放,手术时间分别为59min、70min和90min,术中无副损伤,住院时间分别为8d、7d和9d,3个月后复查示肾及输尿管上段扩张积水显著改善,肾功能良好,无吻合口狭窄。结论经腹膜后腹腔镜输尿管成型术是治疗腔静脉后输尿管的首选方法,熟练的腹腔镜缝合技术、双J管的应用以及后腹膜入路可缩短手术时间。

Objective To investigate the experience and effect of retro-laparoscopic ureteroplasty for retrocaval ureter. Methods Three patients with retrocaval ureter underwent retro-laparoscopic ureteroplasty. Diagnoses were confirmed by IVP and CTU. After isolation of the proximal dilated ureter, the retrocaval segment was dissected and repositioned anterior to the vena cava, and then a tension-free anastomosis was performed with a double J ureteral stent indwelled. Results The ureteroplasty was accomplished successfully in all cases without any adjacent organ or vessel injury. The operative duration were 59 min, 70 min and 90 min respectively. And the hospital stay were 8 d, 7 d and 9 d respectively. No complication occurred. After 3 months＇ follow-up, hydronephrosis and dilating of upper ureter were significantly improved under ultrasonography. The renal function was restored normal and no stenosis of anastomotic stoma was observed. Conclusions Retro-laproscopic ureteroplasty should be recommended as the first choice for retrocaval ureter. Skilled laparoscopic suture techniques, double J stent applications and retroperitoneal approach can shorten the operation time.