腹腔镜膀胱壁瓣法输尿管膀胱再植术

目的 探讨腹腔镜膀胱壁瓣法输尿管膀胱再植术的可行性和临床疗效。方法 采用经腹腔途径施行腹腔镜膀胱壁瓣法输尿管膀胱再植术治疗输尿管出口梗阻9例。左侧1例，右侧7例，双侧1例。4例为单纯性输尿管出口狭窄，1例输尿管出口狭窄伴对侧输尿管结石，1例输尿管出口狭窄者经尿道钬激光切开术后1年出现再次狭窄，1例为开放输尿管膀胱再植术后再发输尿管出口狭窄，1例为泌尿系结核左肾切除术后右侧输尿管出口狭窄，1例为右卵巢囊肿术后双侧输尿管出口梗阻伴发急性肾衰竭2周。B超和IVU检查示重度肾积水6例7侧，中度肾积水3例。结果 9例手术均顺利。手术耗时115～180min/侧，平均132min／侧。术中出血40～150ml，平均62ml。术后1～3d拔除膀胱外引流管下地活动，无一例漏尿。术后1周拔除导尿管，7—14d出院，平均住院时间8d。术后1个月拔除双J管。术后3～6个月膀胱造影显示I度双侧输尿管返流1例，无返流8例。随访3～16个月，B超和IVU、MRU复查无吻合口狭窄，肾积水均得到明显改善，中度肾积水者2例，轻度肾积水者4例，无明显肾积水者3例。结论 腹腔镜膀胱壁瓣法输尿管膀胱再植术手术效果好，抗返流效果佳，刨伤小，是治疗输尿管出口病变的微创新途径。

Transperitoneal laparoscopic bladder-flap ureterovesical implantation

Objective To describe the new technique of transperitoneal laparoscopic bladder-flap ureterovesical reimplantation, and to evaluate its feasibility and clinical efficacy. Methods Of the 9 cases of ureterovesical obstruction (left in 1, right in 7 and bilateral in 1) who underwent transpentoneal laparoscopic bladder-flap ureterovesical reimplantation, 4 cases had been diagnosed to have simple congenital ureter orifice stricture; 1 had ureter orifice stricture with contralateral ureter calculi; 1 had recurrent ureter orifice stricture 1 year after transurethral holmium laser incision; 1 had recurrent ureter orifice stricture after open ureterovesical reimplantation; 1 with urinary TB had right ureter orifice stricture after left nephrectomy; 1 had bilateral ureter orifice stricture with acute renal failure for 2 weeks after right ovarian cystectomy. B-ul-trasound and IVU showed severe hydronephrosis in 6 cases (7 sides) and moderate in 3. Results The operation was successful in all 9 cases with the operative time being 115 - 180 min (mean, 132 min) and blood loss, 40-150 ml (mean, 62 ml). Postoperatively, the extracystic drainage tubes were removed after 1 - 3 d without urine leakage, and the urinary catheters were removed after 1 week. The mean hospitalization was 8 d (range, 7 - 14 d). The double-J stents were removed 1 month after operation. At 3 - 6 months after operation, cystography showed I degree urine reflux in 1 case and no reflux in the others. Follow-up was 3-16 months. B-ultrasound, IVU and MRU showed no anastomotic stricture and remission of hydronephrosis ( moderate in 2 cases, mild in 4 and resolution in 3 ) . Conclusions Transperitoneal bladder-flap ureterovesical reimplantation has minimal invasion, less suffering, excellent anti-urine reflux effect and quicker recovery. It is a new approach to the treatment of ureterovesical obstruction.