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腹腔镜输尿管膀胱再植术(附17例报告)

Transperitoneal laparoscopic ureterovesical reimplantation (report of 17 cases)

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【作者】 张大宏陈岳兵丁国庆许力为刘锋余大敏李新德

【Author】 ZHANG Da-hong,CHEN Yue-bing,DING Guo-qing,et al.Department of Urology,Affiliated Shaoyifu Hospital,Medical College,Zhejiang Univisity,Hangzhou 310016,China

【机构】 浙江大学医学院附属邵逸夫医院泌尿外科浙江大学医学院附属邵逸夫医院泌尿外科 310016杭州310016杭州

【摘要】 目的 探讨腹腔镜输尿管膀胱再植术的可行性及其临床意义。 方法 男 5例 ,女 12例。左侧 7例 ,右侧 10例。 10例为单纯先天性输尿管出口狭窄 ;1例右侧输尿管出口结石和息肉形成 ;2例为开放输尿管膀胱再植术后再发输尿管出口狭窄 ,其中 1例并发输尿管下端 2枚结石 ;1例为重复肾输尿管上单位输尿管出口狭窄并发 2枚结石 ;2例为输尿管出口狭窄作经尿道钬激光切开再次狭窄 ;1例为泌尿系结核左肾切除术后右侧输尿管出口狭窄。重度肾积水 12例 ,中度肾积水 5例。均应用腹腔镜输尿管膀胱再植术治疗 ,其中输尿管膀胱黏膜吻合术 15例 ,膀胱壁袢法 2例。 结果  17例均获得成功。手术耗时 90~ 16 0min ,平均 112min ,术中出血 6 0~ 10 0ml。术后 1~ 3d拔除膀胱外引流管 ,无 1例尿漏 ,术后 1周拔除导尿管 ,术后 1个月拔除双J管。 1例因上尿路结石下移至输尿管膀胱吻合口再次形成梗阻 ,行体外冲击波碎石 (ESWL)治疗 ,无吻合口狭窄。术后半年膀胱造影Ⅲ°输尿管返流 6例 ,Ⅰ°~Ⅱ°输尿管返流 5例 ,无输尿管返流 6例 ;术后 1年Ⅲ°输尿管返流 3例 ,Ⅰ°~Ⅱ°输尿管返流 4例。随访 3~ 2 4个月 ,B超和IVU复查中度肾积水 4例 ,轻度肾积水 5例 ,无明显肾积水 8例。 结论 腹腔镜输尿管膀胱再植术可行 ,输尿管膀

【Abstract】 Objective To introduce the new technique of transperitoneal laparoscopic ureterovesical reimplantation and to evaluate its feasibility and clinical significance. Methods Overall,17 cases (5 men and 12 women) of ureterovesical obstruction (left,7 and right,10) were included.Of them,10 cases were diagnosed with simple congenital ureter outlet stricture;1 had calculi and polyp formation at right ureter outlet;2 had recurrent ureter outlet stricture after open ureterovesical reimplantation (1 of them had 2 calculi at lower part of the ureter);1 had double nephroureteral upper unit ureter outlet stricture with 2 calculi;2 had recurrent ureter outlet stricture after holmium laser section;1 with urinary TB had right ureter outlet stricture after left nephrectomy.Among the 17 cases,severe hydronephrosis occurred in 12,and moderate,in 5.Transperitoneal laparoscopic ureterovesical reimplantation was performed in the 17 cases (ureterovesical anastomosis in 15 and bladder flap ureterovesical reimplantation in 2). Results The operations were all successful in 17 cases with operating time of 90~160 min (mean, 112 min) and blood loss of 60~100 ml.The drainage tubes were removed 1~3 days after surgery without urine leakage.The urinary catheters were removed 1 week after surgery and double J stents,1 month after surgery. Six months after surgery cystography showed Ⅲ°urine reflux in 6 cases, Ⅰ°-Ⅱ° urine reflux in 5 and no reflux in 6.One year after surgery cystography showed Ⅲ° urine reflux in 3 cases, Ⅰ°~Ⅱ° urine reflux in 4 and no reflux in 10.During 3~24 months’ follow-up, ultrasound B and IVU showed moderate hydronephrosis in 4 cases,mild,in 5 and no obvious hydronephrosis in 8. Conclusions Laparoscopic ureterovesical reimplantation is a feasible,less painful and minimally invasive alternative method for treatment of ureterovesical diseases.By comparison,bladder flap ureterovesical reimplantation has better anti-urine reflux effect but more complicated than ureterovesical anastomosis does.Long term efficacies of the methods need further observation.

  • 【文献出处】 中华泌尿外科杂志 ,Chinese Journal of Urology , 编辑部邮箱 ,2004年11期
  • 【分类号】R699
  • 【被引频次】24
  • 【下载频次】301
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