【摘要】 目的 比较开放手术与后腹腔镜手术治疗腔静脉后输尿管的疗效。方法 回顾性分析14例腔静脉后输尿管患者的临床资料,术前均经静脉尿路造影(IVU)、多层螺旋CT、三维尿路成像(MSCTU)等检查而明确诊断。14例中开放手术9例,应用传统的输尿管切断复位矫形术;腹腔镜手术5例,采用后腹腔径路,3个穿刺通道做输尿管切断、复位,移至下腔静脉前方,做端端吻合术。结果 开放手术9例均成功,无并发症。手术时间48～100 min,平均(65.5±2.6)min。术中出血量190～260 ml,平均(208.6±4.5) ml。住院时间14～17天,平均(14.8±1.1)天。术后康复时间45～60天,平均(52.8±1.3)天。后腹腔镜手术5例均成功,无中转手术及并发症。手术时间85～115 min,平均(102.3±3.8)min。术中出血量30～70 ml,平均(45.3±1.1)ml。住院时间6～9天,平均(7.3±0.9)天。术后康复时间16～32天,平均(23.6±2.4)天。后腹腔镜手术患者术后复查B超与IVU,输尿管梗阻均明显缓解,无吻合口狭窄等远期并发症发生。结论 与开放手术比较,后腹腔镜手术治疗下腔静脉后输尿管安全、有效,具有微创、康复快等优点,值得临床上推广。更多还原

【Abstract】 Objective To evaluate the effectiveness of open and retroperitoneal laparoscopic surgical treatment of retrocaval ureter.Methods The clinical data of 14 patients with retrocaval ureter were analyzed retrospectively.All patients with retrocaval ureter were diagnosed by B-ultrasound,intravenous urography(IVU) and multilayer scan CT urography with 3D display(MSCTU).Among 14 cases with retrocaval ureter,9 were treated by open surgical therapy in which traditional orthopedic surgery following the ureter cut off was performed,9 cases were treated with retroperitoneal laparoscopic surgery.The operative process was operated in a laparoscopic transretroperitoneal approach.After exposing the inferior vena cava and ureter,the retrocaval ureteric segment was safely incised.The ureter was then transpositioned to a normal anatomic position followed by laparoscopic intracorporeal uretero and ureteric anastomosis.All cases were successfully followed up.Results The open operation involved 9 cases were successfully performed and no post-operative complications occurred.The mean operation time was(65.5±2.6) min(range from 48 to 100 min).The blood loss was(208.6±4.5) ml(range from 190 to 260 ml) in the operation.The mean hospitalization time was(14.8±1.1) days(range from 14 to 17 days) and the recovery time was(52.8±1.3) days(range from 45 to 56 days).The retroperitoneal laparoscopic surgery in 5 cases were successful without conversion to open surgery and without severe perioperative complications.The mean operation time was(102.3±3.8) min(range from 85 to 115 min) and blood loss was(45.3±1.1) ml(range from 30 to 70 ml) during the operation.The mean hospitalization time was(7.3±0.9) days(range from 6 to 9 days) and recovery time was(23.6±2.4) days(range from 16 to 32 days).No postoperative urine leakage was occurred.No postoperative ureter stenosis was found by B-ultrasound and IVU in patients who received retroperitoneal laparoscopic surgery.Conclusions Retroperitoneal laparoscopic ureteroplasty in patients with retrocaval ureter is safe and effective with less trauma and faster recovery,it can be used as first choice for the treatment of retrocaval ureter.更多还原