小儿腹腔镜下巨输尿管成形术

目的 探讨小儿腹腔镜下输尿管铲状乳头膀胱再植术的可行性和临床效果.方法采用经膀胱外途径行腹腔镜下输尿管铲状乳头膀胱再植术治疗先天性梗阻性巨输尿管症患儿11例.年龄11个月～13岁,平均(5.3±3.9)岁.左侧4例,右侧7例.其中输尿管出口闭锁1例、单纯性输尿管出口狭窄9例、开放输尿管膀胱再植术后(Cohen手术)输尿管出口狭窄1例.B超和IVU示重度肾积水7例、中度肾积水4例. 结果 11例手术均获成功.手术时间70～190 min,平均(103.O±35.3)min.术中出血10～40 ml,平均(18.0±9.5)ml.术后住院时间7～10 d,平均(8.0±1.4)d.无尿漏发生.术后6周拔除双J管,膀胱镜或输尿管镜下见膀胱输尿管吻合口已黏膜化,乳头收缩抗反流效果满意;11例平均随访6(3～24)个月,B超复查患侧肾积水减轻;IVU示成形输尿管排尿好,无梗阻,症状基本消失;膀胱造影未见膀胱输尿管反流. 结论 在熟练掌握腹腔镜操作技术后,应用经膀胱外途径腹腔镜下输尿管铲状乳头膀胱再植术治疗小儿梗阻性巨输尿管症创伤小、抗反流效果好,是治疗小儿梗阻性巨输尿管症的微创新途径.

Laparoscopic ureteroplasty for treatment of congenital obstructive megaureter in children

Objective To evaluate the efficacy and feasibility of laparoscopie intervention for congenital obstructive megaureter in children. Methods Eleven children with congenital obstructive megaureter(left in 4,right in 7)underwent laparoseopie ureteroplasty.One had congenital ureter oririce stenosis,9 had been diagnosed as simple congenital ureter orifice stricture,1 had recurrent ureter orifice stricture after open ureterovesical reimplantation.B-ultrasound and IVU showed severe hydronephrosis in 7 cases and moderate in 4. Results The operation was successful in all cases and none had urine leakage.The mean operating time was 103.0±35.3 min(range 70-190 min).The mean blood loss was 18.0±9.5 ml(range 10-40 ml)and the mean postoperative hospital stay was 8.0±1.4 d(range 7-10 days).The double J stent was removed 6 weeks after operation.The patients were followed up for 3-24 months(mean,6 months).Cystography showed no reflux in all cases during follow-up. Conclusion Laparoscopical ureteroplasty could be a minimal invasive,less suffering technique for the treatment of congenital obstructive megaureter in children.