3D腹腔镜技术在上尿路重建手术中应用的初步探讨

Application of 3D laparoscopic surgery in reconstruction of upper urinary tract

目的：总结3D腹腔镜上尿路重建手术的临床经验，发挥3D腹腔镜技术在手术中的优势。方法：回顾性分析我院2013年3～8月采用3D腹腔镜技术行上尿路重建手术患者12例的临床资料及手术方法：肾盂输尿管连接部梗阻9例，男5例，女4例，年龄9～36岁，平均19岁，左侧6例，右侧3例；输尿管下端梗阻3例，均为女性，年龄22～27岁，平均24岁，均未生育，左侧2例，右1例。肾盂输尿管梗阻采用3D腹腔镜UPJ离断成形术（Anderson-Hynes术），输尿管下端梗阻采用3D腹腔镜输尿管膀胱再植术。均经腹膜外途径完成手术。结果：UPJ离断成形术手术时间平均135min，输尿管膀胱再植术手术时间平均95min。12例患者双J管取出后复查，肾脏积水均有所减轻。结论：3D腹腔镜技术利用其高清的三维立体视野，减小了手术难度，增加了手术精确度，同时又未明显增加患者的费用，符合我国国情，值得临床推广。

Objective： To summarize the experience of 3D laparoscopic surgery in reconstruction of the upper u- rinary tract and to exert the advantage of 3D laparoscopic technology. Method： We analysed the clinical data and surgical methods of 12 cases of upper urinary tract reconstruction with 3D laparoscopic surgery in our hospital from 2013 March to August. There were nine case of ureteropelvic junction obstruction （UPJO）, five males and four females. The average age of these nine cases was 19 （range, 9-36） years, and six patients were found in the left and three in the right. Another three cases were found lower ureteral obstruction who were sterile females. The average age of these three cases was 24 （range, 22-27） years, and two of them were found in the left and one in the right. Nine cases of UPJO underwent 3D laparoscopic approach of Anderson-Hynes pyeloplasty. The rest three cases of lower ureteral obstruction underwent 3D laparoscpic ureteral reimplantation. Result： All patients re- ceived retroperitoneal approach of 3D laparoscopic surgery. The mean operative time of Anderson-Hynes pyelo- plasty was 135 rains and ureteral reimplantation was 95 rains. Hydronephrosis of all cases relieved after double-J tubes were removed. Conclusion.. 3D laparoscopic technique can reduce the difficulty of operation and increase preci- sion of surgery because of its high-definition three-dimensional vision. It is in line with our national conditions and worthy of promotion for no extra expense is needed.