腹腔镜下输尿管膀胱再植术治疗梗阻性巨输尿管病的临床应用

Clinical application of transperitoneal laparoscopic ureterovesical reimplantation in treatment of obstructive megaureter

目的 探讨经腹腹腔镜下输尿管膀胱再植术治疗梗阻性巨输尿管病的手术技巧和临床效果. 方法 2010年3月至2012年3月,我院应用经腹腹腔镜行输尿管膀胱再植术治疗梗阻性巨输尿管病患者10例.男6例,女4例.年龄32 ～ 66岁,平均52岁.病变位于左侧6例,右侧4例,狭窄段长度1～2 cm.术中腹腔镜下游离输尿管狭窄段,按照膀胱外黏膜下隧道法标准行输尿管膀胱再植术. 结果 10例手术均于腹腔镜下完成,无中转开放手术.手术时间80～ 160 min,平均130 min.术中出血量30～50 ml,平均40 ml.术后均无漏尿.术后住院日5～7d,平均6.5 d,术中及术后均未见严重并发症.10例患者随访21～45个月,其中1例术后6个月时膀胱镜检查见输尿管开口狭窄,行内切开后好转;余9例超声及CT检查显示肾积水无进行性加重,其中4例肾积水消失,膀胱造影提示无输尿管反流,肾动态检查提示肾功能有所改善. 结论 腹腔镜下输尿管膀胱再植术治疗梗阻性巨输尿管病具有手术创伤小、术后恢复快、抗反流效果好的优点,值得推广使用.

Objective To investigate the feasibility and clinical effect of transperitoneal laparoscopic ureterovesical reimplantation in treatment of obstructive megaureter.Methods From March 2010 to March 2012,10 cases of obstructive megaureter were treated with transperitoneal laparoscopic ureterovesical reimplantation,among which 6 were male and 4 were female.Six patients had lesion in the left side and 4 in the right side.During the operation,the ureter was gently dissected circumferentially down to the bladder,and the operation was performed according to Lich-Gregoir standard.Results All the operations were successful.The mean operating time was 130 min （range 80 to 160 min）,the mean blood loss was 40 ml （range 30 to 50 ml）,the mean postoperative hospital stay was 6.5 d （range 5 to 7 d）.All the 10 cases were followed up for 21 to 45 months.Endoscopic ureteral stricture incision was performed in 1 patient due to ureterovesical orifice stenosis 6 months after operation,and the patient recovered well.Ultrasound and IVU showed that the hydronephrosis was disappeared or decreased and no obvious urine reflux was found.Nephrodynamic imaging showed the renal function improved.Conclusion Transperitoneal laparoscopic ureterovesical reimplantation is a feasible,safe and minimal invasive alternative method for treatment of obstructive megaureter.