儿童腔静脉后输尿管的诊断及腹腔镜治疗

目的提高儿童下腔静脉后输尿管的诊治水平。方法回顾性分析2002—2006年我院诊治的6例下腔静脉后输尿管患儿的临床资料。6例患儿均行逆行输尿管造影（RU）或多层螺旋CT三维尿路成像（MSCTU）等检查，特征性影像学表现为输尿管呈倒J形或S形；治疗采用微创的腹膜后途径腹腔镜下输尿管矫正复位术，术中将输尿管切断移到下腔静脉前做输尿管端端吻合术。结果6例患儿均术前确诊。术后3～6个月复查症状消失，B超和IVU示肾积水有不同程度减轻。微创的腹膜后途径腹腔镜下输尿管矫正复位术同传统开放手术相比并不增加手术并发症。结论IVU和RU是诊断下腔静脉后输尿管的首选方法；MSCTU是诊断下腔静脉后输尿管最佳的无创性检查方法。输尿管切断复位矫正术是治疗此病较好的手术方法，而腹腔镜治疗腔静脉后输尿管创伤小、美观、恢复快，效果满意，是腔静脉后输尿管有效的微创治疗新手段。

Diagnosis and Treatment by Retroperitoneal Laparescopic Technology in Pediatric Retrocaval Ureter

Objective To improve the level of diagnosis and treatment for congenital retrocaval ureter.Methods The clinical data of 6 pediatric patients with congenital retrocaval ureter in our hospital from 2002 to 2006 were retrospectively analyzed.These cases were diagnosed depending on retrograde ureterography(RU) and/or multi-slice spiral computed tomographic urography(MSCTU).A "S" or "fish hook" deformity presented at the place of obstructed ureter,orthopedics and reduction were performed to cut off the ureter and shift to front of inferior cava vein,then end-to-end anastomose and place to normal anatomic position.Results All the 6 cases were correctly diagnosed preoperatively.The symptom disappeared with hydronephrosis and hydroureter significantly reduced on B ultrasonography and intravenous urography(IVP),and no ureter restenosis was occurred postoperatively.Compared with open surgery,retroperitoneal laparoscopic technology was less invasive.Conclusions Intravenous urography(IVP) and retrograde ureteropyelography(RP) are the first choice for the diagnosis of retrocaval ureter.MSCTU is the most accurate noninvasive diagnostic procedure.Laparoscopic surgery is a minimally invasive,safe and effective therapy,with satisfactory cosmetic outcome.It should be the first choice for retrocaval ureter.