腹腔镜舌黏膜输尿管成形术修复输尿管上段狭窄的初步临床应用

Laparoscopic ventral onlay lingual mucosal graft ureteroplasty for repair of proximal ureteral stricture:initial experience and short-term outcome

目的：评估腹腔镜舌黏膜输尿管成形术修复输尿管上段狭窄的安全性及临床疗效。方法：2015年6月,我院采用腹腔镜舌黏膜补片输尿管成形术治疗1例输尿管上段狭窄男性患者,术中见输尿管上段狭窄长3.0cm,有1.0cm完全闭塞,遂取长4.6cm、宽1.0-1.5cm的舌黏膜,成功修复输尿管上段狭窄。结果：手术时间105min,术中出血20ml,术中术后无并发症发生。术后2周患者发音吐字清晰。术后8周拔除双J管,12周B超复查左肾无积水,输尿管上段无扩张。结论：腹腔镜辅助下舌黏膜补片输尿管成形术修复输尿管上段狭窄是一种很好的可选术式,短期效果安全可行,但仍需大宗病例及长期随访来验证和评估此手术的远期疗效。

Objective：To evaluate the safety and efficacy of laparoscopic ventral onlay lingual mucosal graft for reconstruction of proximal ureteral stricture.Method：In June 2015,a male patient underwent laparoscopic ventral onlay lingual mucosal graft ureteroplasty for proximal ureteral stricture.The length of upper ureteral stricture was30 mm including 10 mm of complete occlusion.Then 46 mm in length and 10-15 mm in width lingual mucosal graft was harvested and placed in the strictured ureter as a ventral onlay for laparoscopic ureteroplasty.Result：The patient underwent successfully the new technique surgery.The operation time was 105 minutes,and estimated blood loss was 20 ml.There were no perioperative complications.The patient recovered the clear pronunciation of words two weeks postoperatively.The stent was removed eight weeks postoperatively.Neither hydronephrosis nor proximal ureter dilatation in the left side was found through ultrasound examination 12 weeks postoperatively.Conclusion：Laparoscopic ventral onlay lingual mucosal graft ureteroplasty is a feasible option for reconstruction of proximal extensive ureteral stricture.Although the results of the initial experience are encouraging,a bigger series study and longer follow-up period are recommended to evaluate our procedure.