腹腔镜改良乳头插入法输尿管膀胱再植术临床效果观察

Clinical effect observation of modified ureteral-nipple technique in laparoscopic extravesical ureteral reimplantation

目的:通过改良插入式乳头法对15例输尿管末段狭窄的患者施行腹腔镜输尿管膀胱再植术,并对临床效果进行分析。方法:本组15例患者,术前诊断均为输尿管末段狭窄,其中男5例,女10例,平均年龄37.5岁。术前超声、IVU、CTU等检查提示上尿路扩张积水Ⅳ~Ⅴ级。所有病例均采用经腹腔途径,手术要点包括输尿管游离和离断、输尿管自Trocar孔拉出体外行乳头成形和双J管置入、再放回腹腔行输尿管膀胱再植。结果:15例患者手术均顺利完成,平均手术时间159.7min,术中平均失血量76ml,术后引流管引流量平均170ml;术后随访3~12个月,影像学改善率100%,积水完全消失3例,积水等级降为Ⅰ级10例,降为Ⅱ级2例。2例患者出现无症状、无需特殊处理的Ⅰ度输尿管反流。结论:改良插入式乳头法行腹腔镜输尿管膀胱再植术是安全、可靠和简便有效的手术方法。

Objective：To describe a modified technique in laparoscopic extravesical ureteral reimplantation surgery in a series of 15 cases.Method：A group of 15 patients with distal ureteral obstruction undergoing our modified surgery procedures were enrolled in the study,including five males and ten females with an average age of37.5years old.Preoperative image examinations all revealed upper ureteral tract expansion and hydronephrosis for GradeⅣ-Ⅴ.The modified laparoscopic reimplantation was performed through transperitoneal approach and jointed with four key procedures：ureter mobilization and transection,pulling ureter out of trocar,extracorporeal nipple shaping and doube-J tube placement,restoring shaped ureter into peritoneal cavity and ureterovesical anastomosis with direct insertion.Result：All surgeries were completed successfully without conversion to open surgery.The mean operative time was 159.7min,mean intraoperative blood loss was 76 ml,and mean postoperative drainage volume was 170 ml.Follow-up period covered 3-12 months,and 100% radiographic resolution was showed：three patients showed normal drainage of collection system with no expansion,while ten patients were favored with lower expansion level of Grade I and two patients with GradeⅡ compared with preoperative status.Two patients got a level-Ⅰ vesicoureteral reflux with no symptom,and no further invention was needed.Conclusion：Modified laparoscopic extravesical ureteral-nipple reimplantation is technically effective,reliable and feasible.