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  • 付成龙,张超,过菲,王辉清,彭广,杨波,许传亮,孙颖浩.输尿管体外修剪在腹腔镜输尿管膀胱再植术中的应用[J].第二军医大学学报,2019,40(4):451-454    [点击复制]
  • FU Cheng-long,ZHANG Chao,GUO Fei,WANG Hui-qing,PENG Guang,YANG Bo,XU Chuan-liang,SUN Ying-hao.Application of external ureteral clipping in laparoscopic ureterobladder reimplantation[J].Acad J Sec Mil Med Univ,2019,40(4):451-454   [点击复制]
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输尿管体外修剪在腹腔镜输尿管膀胱再植术中的应用
付成龙1,2,张超1,过菲1,王辉清1,彭广1,杨波1*,许传亮1,孙颖浩1
0
(1. 海军军医大学(第二军医大学)长海医院泌尿外科, 上海 200433;
2. 昆山市第四人民医院泌尿外科, 昆山 215300
*通信作者)
摘要:
目的 探讨体外修剪输尿管断端及置入双J管在腹腔镜下输尿管膀胱再植术中的可行性和有效性。方法 回顾性分析2014年3月至2016年3月行腹腔镜输尿管膀胱再植术治疗的21例输尿管出口梗阻患者的资料。其中12例行常规腹腔镜输尿管膀胱再植术(对照组),9例行腹腔镜配合体外操作输尿管膀胱再植术(改良组)。改良组患者均于腹腔镜下游离患侧输尿管,离断狭窄段输尿管,将近端输尿管沿12 mm Trocar孔拉出体外;直视下修剪输尿管断端并向输尿管内置入双J管,用4-0可吸收线将双J管固定在输尿管黏膜上,然后将其送入腹腔;在腹腔镜下游离膀胱,吻合膀胱和输尿管。结果 21例患者均顺利完成手术,无一例中转开放手术,术后均未发生漏尿。改良组患者手术时间短于对照组[(77±17)min vs(104±20)min,P<0.05]。21例患者术后随访半年,超声及静脉肾盂造影检查均提示无输尿管吻合口狭窄,肾积水不同程度减轻;膀胱造影提示有2例存在输尿管反流(对照组及改良组各1例)。结论 在腹腔镜输尿管膀胱再植术中,应用体外修剪输尿管断端及置入双J管可在保证微创的前提下缩短手术时间、降低手术难度。
关键词:  腹腔镜  输尿管下端狭窄  输尿管膀胱再植术  输尿管体外修剪
DOI:10.16781/j.0258-879x.2019.04.0451
投稿时间:2018-08-06修订日期:2018-12-04
基金项目:
Application of external ureteral clipping in laparoscopic ureterobladder reimplantation
FU Cheng-long1,2,ZHANG Chao1,GUO Fei1,WANG Hui-qing1,PENG Guang1,YANG Bo1*,XU Chuan-liang1,SUN Ying-hao1
(1. Department of Urology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Urology, Fourth People's Hospital of Kunshan, Kunshan 215300, Jiangsu, China
*Corresponding author)
Abstract:
Objective To explore the feasibility and effectiveness of external ureteral clipping and insertion of double J tube in laparoscopic ureterobladder reimplantation. Methods The clinical data of 21 patients with lower ureteral stricture undergoing laparoscopic ureterobladder reimplantation from Mar. 2014 to Mar. 2016 were retrospectively analyzed. Twelve patients receiving conventional laparoscopic ureterobladder reimplantation were assigned to control group, and 9 patients receiving laparoscopy-assisted external ureterobladder reimplantation were assigned to improvement group. The ureter of the patients in the improvement group was separated under laparoscopy, the narrow ureter was severed, and the proximal ureter was taken out from the 12-mm Trocar. Then, the broken end of ureter was clipped under euthyphoria, and the double J tubes were inserted and fixed on the ureteral mucosa with 4-0 absorbable sutures and then sent back to the pelvis. The bladder was mobilized under laparoscopy, and the bladder and ureter were anastomosed. Results The surgery was successfully completed in all the 21 patients without transferring to open surgery or urine leakage after operation. The operation time was significantly shorter in the improvement group versus the control group ([77±17] min vs[104±20] min, P<0.05). All patients were followed up for at least 6 months after operation. Both ultrasonography and intravenous pyelography showed no ureteral anastomotic stricture. The hydronephrosis was alleviated to some extent. Cystography showed that 2 patients had reflux, with 1 case in each group. Conclusion In laparoscopic ureteral reimplantation, external ureteral clipping and insertion of double J tube are minimally invasive, and can shorten operation time and make the surgery less complex.
Key words:  laparoscopy  lower ureteral stricture  ureterobladder reimplantation  external ureteral clipping