靶向指引腹腔镜先天性膀胱憩室切除术临床分析

Clinical analyses of laparoseopic congenital bladder diverticulectomy with target-guided method

目的总结靶向指引方法（导尿管和膀胱镜光源照射）微创治疗12例先天性膀胱憩室患儿的经验。方法回顾性分析2006年1月至2016年1月在我科诊治的先天性膀胱憩室患儿资料，内容包括年龄、性别、主诉、憩室大小、临床尿动力数据、手术治疗方法。结果12例患儿均成功手术，无中转开腹，手术时间120～160 min，平均135 min，术中出血20～75 ml，平均40 ml。2例患儿发现膀胱结石，2例患儿术前发现轻度膀胱输尿管反流，未行输尿管膀胱再植术。术后无明显并发症，2例随访3个月，10例随访1年，术后3个月复查中段尿培养和泌尿系彩超；6个月复查排尿膀胱尿道造影（VCUG），尿流动力学；1年复查泌尿系彩超。结论诊断先天性膀胱憩室需排除下尿路梗阻引起的继发憩室，VCUG是其诊断的金标准，结合膀胱镜，尿流动力学检查可明确诊断。目前缺乏统一的手术标准，推荐手术指征：直径大于3 cm的憩室，有临床表现如泌尿系感染、排尿困难、尿潴留的憩室。靶向指引方法利用导尿管水囊和膀胱镜光源照射可有效帮助术者辨认膀胱憩室壁，在完整切除憩室的同时避免损伤输尿管，输精管，精囊及盆从神经，减少手术并发症。

ObjectiveTo summarize the experiences of mini-invasive surgery for congenital bladder diverticulum （CBD） by target-guided method of urethral catheter and cystoscope light source in children.MethodsRetrospective reviews were conducted for age, gender, chief complaint, diverticula size, clinical and urodynamic findings and surgical approaches of 12 CBD patients from January 2006 to January 2016.ResultsAll children were successfully operated without any conversion into laparotomy. The average operative duration was 135 （120-160） mins and the average volume of blood loss 40 （20-75） ml. Two cases of bladder calculus were detected. And another two cases of mild vesicoureteral reflux did not undergo ureteral bladder replantation. There was no onset of overt postoperative complications. Two cases were followed up for 3 months and the remainder for 1 year. Re-examinations included urinary culture and urinary ultrasound after 3 months; voiding cystourethrography （VCUG） and urodynamic examination after 6 months; urinary ultrasound after 1 year. The follow-up outcomes were excellent.ConclusionsCongenital bladder diverticulum should be differentiated from lower urinary tract obstruction due to secondary diverticulum. As a gold diagnostic standard, VCUG may be combined with cystoscopy and urodynamic examination for a definite diagnosis. Surgical intervention criteria for congenital bladder diverticula have not been made. Recommended surgical indications include a diverticulum with a diameter of 〉3 cm or a diverticulum associated with such clinical symptoms as urinary tract infection, dysuria and urinary retention The above targeted method may aid the identification of diverticulum wall of bladder, avoid the damages of ureter, vas deferens, seminal vesicles and pelvic plexus and reduce the occurrences of operative complications during complete removal of diverticulum.