后腹腔镜输尿管端端吻合术治疗下腔静脉后输尿管(附8例报道并文献复习)

目的:报道后腹腔镜输尿管端端吻合术治疗下腔静脉后输尿管的手术技术和临床效果;并复习有关腹腔镜技术治疗下腔静脉后输尿管的文献。方法:8例术前均接受IVP和(或)逆行造影检查。使用后腹腔途径、三个穿刺通道行输尿管端端吻合术。术后3和6个月复查IVP,随后每年复查B超或IVP。结果:8例手术均获成功。平均手术时间78min。术中出血量可忽略不计(少于10ml)。术后肠功能恢复时间24~48h。腹膜后引流管拔除时间一般为2~3天。平均术后住院时间6.5天。未出现围术期并发症。术后4~6周拔除双J管。平均随访23个月,复查B超和(或)IVP,无吻合口狭窄,输尿管梗阻均明显缓解。6例术前有疼痛症状者完全缓解。结论:后腹腔镜输尿管端端吻合术治疗下腔静脉后输尿管安全可行,平均近2年的随访显示出很好的手术效果。结合复习的文献报道结果,腹腔镜手术可能会成为治疗下腔静脉后输尿管的首选方式。

Retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter (Report of 8 cases and literature review)

Objective:To present our surgical techniques and experience with retroperitoneal laparoscopic ureteroureterostomy in eight patients with retrocaval ureter, and review the published reports on the laparoscopic management of retrocaval ureter.Methods:Eight patients with retrocaval ureter underwent laparoscopic ureteroureterostomy. A three-port, finger and balloon-dissecting, retroperitoneal approach was used. The retrocaval segment of ureter was mobilized and transposed anterior to the inferior vena cava. The ureteroureteral anastomosis was completed with the intracorporal free hand suturing and in situ knot tying techniques. Intravenous pyelography was performed 3 and 6 months postoperatively. Thereafter, yearly follow-up was performed by obtaining either an intravenous pyelography or renal ultrasonography. A comprehensive literature review was conducted.Results:All operations were completed laparoscopically without conversion to open surgery. The mean operative time was 78 minutes. The blood loss was minimal. No perioperative complication occurred. All patients achieved an uneventful recovery. At a mean follow-up of 23 months, remarkable improvement in the ureteral obstruction was observed. Data of twenty-four patients in fourteen published literatures were reviewed.Conclusions:Our results in this series of eight patients indicate that retroperitoneal laparoscopic ureteroureterostomy is a safe and effective procedure and an excellent minimally invasive treatment option for retrocaval ureter. In addition to our experience, a thorough review of published reports supports our view that laparoscopic surgery should probably be the first line treatment for retrocaval ureter.