自制发光输尿管导管系统在腹腔镜手术中预防输尿管损伤的临床应用

目的探讨自制发光输尿管导管系统在腹腔镜手术中预防医源性输尿管损伤的有效性。方法腹腔镜手术操作前,在膀胱镜直视下向输尿管插入发光输尿管导管系统约22～30cm(因人而异),术中由助手协助操作间歇或连续按压电钮让已插入输尿管导管发光便于术者辨认或者避开输尿管。结果66例输尿管上段结石,22例肾盂结石都能准确快速找到病变部位,避免损伤周围血管;106例子宫切除术无1例损伤输尿管;22例直肠肿瘤手术(包括2例粘连严重腹腔镜下无法顺利完成手术改开放手术)均未损伤输尿管。结论腹腔镜下微创手术应用自制发光输尿管导管系统能有效预防医源性输尿管损伤。     

预置输尿管导管在妇科复杂腹腔镜手术中的应用

目的:探讨预置输尿管导管在妇科复杂腹腔镜手术中的应用价值。方法:选取200例妇科复杂腹腔镜手术,术前均用膀胱镜置入双侧输尿管导管,然后行腹腔镜手术,术中在导管指示下手术,术后立即拔除导管,其中宫颈癌根治术20例,全子宫切除术68例,鞘内子宫切除术43例,卵巢囊肿剥除术25例,子宫肌瘤切除术26例,子宫内膜异位症病灶清除术18例。结果:双侧输尿管置管成功率99.5%,200例中无一例损伤输尿管,明显降低了输尿管损伤的发生率。结论:在妇科复杂腹腔镜手术中应用输尿管导管可明显降低术中损伤输尿管的可能性。     

纤维可视输尿管导管在盆腔粘连患者腹腔镜子宫切除术中的应用

目的:探讨盆腔粘连患者行腹腔镜子宫切除术时放置纤维可视输尿管导管预防输尿管损伤的可行性。方法:随机选取盆腔粘连患者177例,实验组98例于术前在膀胱镜下放置输尿管导管,对照组79例按正常程序实施手术。结果:实验组避免输尿管损伤有效率为100%,对照组有效率为91.14%,差异有统计学意义(P<0.05)。在子宫次全切除术及子宫全切除术中,实验组手术时间均明显短于对照组(P<0.001),差异有统计学意义。结论:盆腔粘连患者行腹腔镜下子宫切除术时放置纤维可视输尿管导管,可有效防止输尿管损伤,手术操作安全,快捷。     

输尿管插管在预防妇科三、四级腹腔镜手术中输尿管损伤的应用价值

目的：探讨输尿管插管在预防妇科三、四级腹腔镜手术中输尿管损伤的应用价值。方法选取2009年1月～2011年11月182例我科三、四级腹腔镜手术182例作为研究组,术前均用膀胱镜放置双侧输尿管导管,然后行腹腔镜手术,术中在输尿管导管指示下手术,术后立即拔除导管。选取同期我科三、四级腹腔镜手术200例作为对照组,术前未行输尿管插管,比较2组患者术后输尿管损伤的发生率。结果研究组双侧输尿管置管成功率98．9％（180/182）,无一例损伤输尿管。对照组术后发现输尿管损伤2例,开腹行输尿管修补术并留置双J管,术后2个月治愈;膀胱损伤2例,术中均及时发现,立即请泌尿外科会诊,在泌尿外科大夫的协助下及时行膀胱修补术,术后留置尿管2周治愈。2组并发症发生率无统计学差异（ P＝0．125）。结论在妇科三、四级腹腔镜手术中应用输尿管导管可减少术中输尿管损伤的发生。     

膀胱镜检术在妇科腹腔镜手术输尿管损伤预防及早期诊断中的作用

目的探讨膀胱镜检术及输尿管插管在妇科腹腔镜手术输尿管损伤的预防及早期诊断中的价值。方法回顾中山大学附属第三医院妇科2006年1月至2012年9月期间2542例腹腔镜手术，对复杂病例（18例）及输尿管损伤病例（3例）进行总结分析。结果有7例病例术前检查提示病灶压迫输尿管或考虑盆腔粘连严重，为预防输尿管损伤，手术开始时先行膀胱镜下输尿管置管，结果无一例发生输尿管损伤。1I例病例因手术困难，手术结束前进行膀胱镜检查，发现输尿管损伤2例。2542例共发生输尿管损伤3例，其中2例在上述膀胱镜检查中发现，另外1例手术顺利，手术后两周出现腰痛，行静脉。肾盂造影发现输尿管损伤。结论输尿管损伤是妇科腹腔镜手术的严重并发症之一，对于复杂病例，手术时行膀胱镜下输尿管置管或膀胱镜检查，能一定程度上预防及早期发现输尿管损伤。     

输尿管导管技术在腹腔镜全子宫切除术中的应用价值

目的:探讨输尿管导管技术在腹腔镜全子宫切除术中的应用价值.方法:回顾分析158例腹腔镜全子宫切除术患者的临床资料.其中87例术前于膀胱镜引导下行双侧输尿管插管,71例未插管.结果:87例输尿管插管患者无一例发生输尿管损伤.未插管组5例发生输尿管损伤,1例术中发现损伤,用3-0可吸收线间断缝合破口,术后留置双J管,3个月...     

腹腔镜输尿管重建在子宫手术所致输尿管损伤中的应用

目的探讨腹腔镜重建技术用于治疗子宫手术所致输尿管损伤的临床疗效。方法子宫手术所致输尿管损伤病人20例,均采用腹腔镜技术进行处理,选择经腹腔入路,首先在髂外动脉前方或上方找到输尿管,完全游离输尿管下段,于损伤部位上方1 cm处将其切断,输尿管与膀胱行乳头吻合。结果平均手术时间96分钟,无中转开放手术,无输血,无严重并发症。术后随访4～26个月,5例有轻度肾积水,1例左侧输尿管口狭窄行球囊扩张治疗后好转。结论腹腔镜输尿管重建治疗子宫手术输尿管损伤,创伤小,安全性高,疗效确切。     

妇科腹腔镜手术输尿管损伤26例临床分析

目的 总结妇科腹腔镜手术输尿管损伤的诊治经验。方法 回顾性分析2017年1月～2021年12月24 097例妇科腹腔镜手术中26例(0.11%)输尿管损伤的临床资料。宫颈癌19例，子宫内膜癌3例，子宫腺肌症合并深部浸润型子宫内膜异位症2例，宫颈原位癌1例，卵巢癌1例。广泛性子宫切除术21例，其他子宫切除术3例，高位腹主动脉旁淋巴结切除术1例，肿瘤细胞减灭术乙状结肠切除时1例。术中发现输尿管损伤4例，术后发现22例。损伤部位为输尿管近膀胱入口处24例，腹段与盆段交界处1例，肠系膜下动脉起始处1例。4例术中发现损伤即行修复手术，术后发现损伤的22例中，放置双J管11例，输尿管膀胱再植术11例(一期手术6例，二期手术5例)。结果 除1例二期手术后继发输尿管狭窄定期更换双J管外，余25例拔除双J管后随访6～24个月(平均9个月),均无漏尿、中重度肾积水及输尿管扩张，肾功能正常。结论 妇科腹腔镜手术输尿管损伤常发生于宫颈癌广泛性子宫切除术及困难的全子宫切除术中，多为术后迟发性损伤，与电热损伤及过度游离输尿管有关，及时诊治预后良好。     

腹腔镜手术致输尿管损伤2例

例1　女,40岁。因子宫肌瘤行腹腔镜子宫切除术,术后6d出现右下腹阵发性疼痛。体检:右肾区叩痛,右下腹压痛。B超:右肾盂扩张2 .7cm ,右输尿管上段扩张1 .3cm ,发现盆腔积液5 .6cm×1 .6cm。术后8d出现阴道漏液,留置尿管后漏液量无减少,漏液常规检查及肌酐、尿素氮测定与尿液无明显差别。静脉注入美蓝后漏液呈淡蓝色。IVP右肾盂积水,右输尿管上、中段扩张,下段显影中断,膀胱后方见造影剂外溢。诊断:右输尿管损伤。行膀胱镜右输尿管插管,进入右输尿管口2cm后受阻,遂行手术探查,发现损伤位于右输尿管下段,行输尿管膀胱再植术,术中置双J导管。…     

妇科手术致输尿管损伤腹腔镜一期处理探讨(附5例报告)

目的 探讨妇科手术致输尿管损伤的腹腔镜一期处理的治疗效果.方法 回顾性分析腹腔镜一期处理的5例妇科手术致输尿管损伤患者的临床资料和治疗结果.结果 5例患者,术后2～10天发现,均行膀胱美篮试验,排除膀胱瘘,行膀胱镜下输尿管逆行插管有造影剂外渗,证实为输尿管中、下段瘘.4例行输尿管端端吻合+双J管置入术,1例行输尿管膀胱黏膜下隧道再植,并留置双J管.5例患者术后住院4～7天,平均5天;术后1～2个月自膀胱内取出双J管,IVU检查示输尿管吻合处通畅,患肾形态、功能正常.结论 对妇科手术致输尿管损伤患者,腹腔镜一期处理临床效果好.     

6/7.5 F输尿管镜联合输尿管导管负压吸引治疗输尿管上段结石216例报告

目的探讨应用6/7.5 F输尿管镜联合旁置输尿管导管负压吸引治疗输尿管上段结石的安全性及有效性。 方法回顾性分析深圳市前海蛇口自贸区医院2019年1月至2020年12月采用6/7.5 F输尿管镜联合旁置输尿管导管负压吸引配合钬激光碎石治疗输尿管上段结石患者216例的临床资料。留置5 F输尿管导管越过结石上方,连接负压吸引,应用200 μm钬激光击碎结石。 结果216例患者中,术中共209例输尿管镜成功到达结石下方位置,上镜成功率96.8%;18例因整体或大部分结石移位至肾盂,一期行输尿管软镜碎石,结石上移率8.3%;术后低热5例,高热1例,感染率2.7%;拔管后20例KUB提示有>4 mm结石残留,清石率90.7%;所有病例均无输尿管穿孔、黏膜撕脱、感染性休克等严重并发症。 结论6/7.5 F输尿管镜联合旁置输尿管导管负压吸引治疗输尿管上段结石安全、有效,可降低结石上移逃逸率,提高术后清石率,减少术后感染,临床效果确切。     

超声引导经皮肾镜术中不置输尿管导管的安全性探讨

目的 探讨超声引导经皮肾镜取石术中(PCNL)不置输尿管导管的可靠性及安全性.方法 采用PCNL 治疗合并一定肾积水的肾和输尿管上段结石120 例,入选病例随机分为2 组,A 组(不使用输尿管导管)60 例,B 组(使用输尿管导管)60例,两组性别、年龄、结石大小、结石停留时间、同侧肾盂分离距离无统计学差异.统计麻醉时间、手术时间、住院时间、医疗费用、结石清除率、术后发热、术中失血量等指标.结果 2 组平均手术时间、结石清除率、住院时间、术中失血量无显著性差异(P>0.05);麻醉时间、医疗费用、术后发热A 组显著低于B 组(P<0.05).结论 对于肾盂分离>10 mm 的肾积水患者,超声引导PC原NL不置输尿管导管是一种经济、可靠、安全的方法.     

Laparoscopic ureteroureteral anastomosis for repair of ureteral injury involving stricture

We describe an approach to laparoscopic ureteroureteral anastomosis for surgical management of ureteral stricture, and review four cases in which this method was used. In these four cases, we observed no intraoperative complications. Patients length of hospital stay was 1–2 days. Follow-up ranged from 12 to 14 months. All four patients have been asymptomatic, and their follow-up intravenous pyelograms (IVPs) have been normal. This surgical approach warrants further study with larger series and long-term follow-up.Editorial Comment: As experienced laparoscopists advance their abilities to tackle difficult problems once only remedied by laparotomy, they need to be cognizant of a few points. The ability to help the patient and lessen suffering is paramount, and laparoscopy can accomplish this in the hands of experienced surgeons. The general rule of thumb—that principles of laparoscopic surgery need to mirror its laparotomy counterparts—is crucial. One cannot forget that when a proper retroperitoneal dissection is warranted, exposure and anatomical considerations, such as ureteral blood supply in the distant third of the ureter, need to be considered. The success of such a small series certainly raises the idea that a laparoscopic approach to fixing a ureteral injury is possible and beneficial if done appropriately and by experienced hands.     

Laparoscopic ureteral reimplant for distal ureteral strictures.

BACKGROUND AND OBJECTIVES: The incidence of ureteral injuries is on the rise. Endoscopic treatment of long distal ureteral strictures is associated with poor success rates, and open ureteral reimplantation is a potentially morbid surgical procedure. The objective of this study was to review our early results with laparoscopic ureteral reimplantation. METHODS: Between May 2004 and February 2007, 6 patients with ureteral strictures secondary to either gynecological surgery (4) or urolithiasis (2) presented for treatment. These patients failed traditional conservative treatment and underwent laparoscopic ureteral reimplantation. RESULTS: Five of the 6 cases were performed completely laparoscopically, while one patient had an elective open conversion to complete the vesicoureteral anastomosis. No major intraoperative or postoperative complications were encountered. The mean operating room time was 277 minutes (range, 180 to 360). The average hospital stay was 2.7 days (range, 2 to 5). All patients had a successful outcome defined as no evidence of radiographic obstruction and no clinical complaints of persistent renal colic. Mean follow-up was 13.2 months (range, 2 to 33). CONCLUSION: Our early results demonstrate that laparoscopic ureteral reimplantation is an effective minimally invasive treatment option for distal ureteral strictures.     

Ureteral stent placement in hydronephrosis during pregnancy

Summary In this study we describe 22 cases of retrograde ureteral stent placement in pregnant women with therapy-resistant flank pain due to hydronephrosis. Eleven were primiparous and one patient expected twins. Eight of 22 patients presented symptoms of pyelonephritis. In 21 cases the hydronephrosis was located on the right and in 4 cases it was bilateral. Maximal lower calix diameter was 12 mm (range 9–22 mm). With the exception of two cases, sonographically controlled stent placement was performed under local anesthesia without sedation. All patients were painfree within 6 days and were given prophylactic low dosis of antibiotic until the day of delivery. Renal function remained within the normal limits. Double-J stent displacement occured in 3 patients – of which one underwent nephrostomy. Postnatal examination demonstrated urolithiasis in 4 of 19 patients. This study provides evidence for effectiveness of retrograde ureteral Double-J stent placement as a therapeutic option in cases of severe symptomatic hydronephrosis during pregnancy with a low morbidity rate.