输尿管镜辅助腹腔镜下“插入式”输尿管膀胱再植术

"Inserting" ureterovesical reimplantation by means of laparoscopy assisted with ureteroscopy

目的探讨输尿管镜辅助腹腔镜下“插入式”输尿管膀胱再植术的手术技巧和临床效果。方法应用输尿管镜辅助腹腔镜下“插入式”输尿管膀胱再植术治疗输尿管出口狭窄20例。全麻，仰卧低截石位，先行经尿道膀胱、输尿管口镜检，然后建立腹腔镜工作通道，游离输尿管，于梗阻上方离断，自同侧10mmtrocar切口拉出腹壁，缝制输尿管口半乳头，置入双J管并固定，回纳腹腔。在输尿管镜辅助下，于膀胱顶后壁与输尿管行再植术。结果除1例患者输尿管镜检发现输尿管肿瘤，改开放手术外，其余19例手术均获成功，手术时间85～150min，平均（106±34）min。术后1周拔除尿管，1个月拔除双J管，无尿漏。随访2—24个月。静脉尿路造影（WU）、超声提示肾积水消失或明显减少，膀胱造影未见输尿管反流。1例吻合口狭窄，行内切开术后治愈。结论输尿管镜辅助腹腔镜下“插入式”输尿管膀胱再植术能为术者提供更全面的术野，两镜相互配合，手术简便快捷，疗效确切，值得开展。

Objective To investigate the technique and the clinical effect of ＂inserting＂ ureterovesical reimplantation by means of laparoscopy assisted with ureteroscopy. Method 20 patients with ureter outlet stricture underwent ＂inserting＂ ureterovesical reimplantation by laparoscopy assisted with ureteroscopy. Under general anaesthesia, the patients were in supine lithotomy position. Firstly, the ureter, bladder and ureterostoma were examined by ureteroscopy. Secondly, channels of laparoscopy were established, the ureter was separated through laparoscopy and was reseeted at the upper obstruction, which was drawn out from the 10 mm trocar of the same side. After ureterostoma was stitched up like half of a nipple, the double J stents were placed and fixed into the ureter, which was put inside abdominal cavity. Results The operations were successful in 19 cases with operating time of 85-150 min （mean, 106_＋34 min）, except that one case were converted to open surgery after being diagnosed as ureteral carcinoma through ureteroscopy. The urinary catheters were removed 1 week after surgery and double J stents, 1 month after surgery. None presented with urinary leakage. All cases have been followed up for 2 to 24 months. Intravenous urography and ultrasound suggested hydronephrosis disappeared or decreased apparently while urine reflux wasn＇t found by cystography. In one case anastomotic stricture occurred, which was cured with endoureterotomy. Conclusions ＂Inserting＂ ureterovesical reimplantation by means of laparoscopy assisted with ureteroscopy can provide the operator with broader field of operation, with ureteroscopy and laparoseopy acting together, which is simple, convenient, effective and has a perfect prospect for clinical application.