腹腔镜下膀胱腰大肌悬吊法处理输尿管中长段损伤的初步研究

目的评价腹腔镜下膀胱腰大肌悬吊输尿管膀胱再植术治疗输尿管远端缺损的有效性及安全性。方法回顾性分析本院2014年4月至2018年3月期间行腹腔镜下膀胱腰大肌悬吊法处理的输尿管下段较长缺损患者15例。其中男性患者6例,女性患者9例,年龄23~68岁,平均42岁。病变位于左侧10例,右侧5例。彩超提示肾盂分离平均2.7(1.4~5.2)cm,患者平均体重指数(BMI)为23.8(19.8~28.5)kg/m^2。术前评估缺损段长度平均4.8(3.0~8.0)cm。结果所有患者手术均经腹腔镜顺利完成,无中转开放。患者平均手术时间为125(90~210)min,平均手术失血量是75(30~150)mL。术后平均尿管拔除时间为7.2(5.0~11.0)d,术后平均住院8.7(5.0~14.0)d,术后输尿管支架管平均拔除时间为46(28~90)d,平均随访时间19.2(4.0~34.0)个月。围手术期无重大并发症,所有患者均出现症状缓解,排尿良好。结论腹腔镜下膀胱腰大肌悬吊输尿管膀胱再植术治疗输尿管下段较长缺损安全、有效,具有学习曲线短,手术创伤小,出血少,术后恢复快,并且可以完全保证输尿管无张力及连续性等优点,短期随访效果满意。

Laparoscopic ureteroneocystostomy combined with psoas hitch in the treatment of mediumlength distal ureteral defects

Objective To evaluate of the efficacy and safety of laparoscopic bladder lumbar psoas muscle suspension ureteral bladder replantation in the treatment of distal ureteral defect.Methods We retrospective studied laparoscopic bladder lumbar muscle suspension method of treatment of the lower ureteral defect in 15 cases in our hospital from April 2014 to March 2018.There were 6 male patients and 9 female patients,aged from 23 to 68 years,with an average age of 42 years.The lesion was located in 10 cases on the left and 5 cases on the right.The mean BMI of the patients was 23.8(19.8-28.5)kg/m^2.The length of the defect was 4.8(3-8)cm.Results Transperitoneal laparoscopic ureteroneocystostomy was performed in all cases.The mean operative time(ORT)was 125(90-210)min and estimated blood loss(EBL)was 75(30-150)mL.Average hospital stay was 8.7(5.0-14.0)days.Follow-up time was 19.2(4-34)months.The D-J stent was removed after 6 weeks following repair in all patients.All patients experienced symptomatic relief and showed good urine drainage.Conclusions Laparoscopic bladder lumbar psoas muscle suspension ureteral bladder replantation in the treatment of distal ureteral defect is safe and effective.It has the advantages of short learning curve,less surgical trauma,less bleeding,rapid postoperative recovery,and can completelyguarantee the tension-free and continuous ureter.The short-term follow-up results are satisfactory.