后腹腔镜输尿管成形术治疗下腔静脉后输尿管的经验总结

目的报道12例后腹腔镜输尿管成形术治疗下腔静脉后输尿管的临床疗效并总结经验。方法2010年3月至2012年12月纳入于北京大学第一医院及内蒙古医科大学附属医院就诊的下腔静脉后输尿管患者共12例，其中男5例，女7例。患者平均年龄为22．3岁（13～34岁），平均病程为1．1个月。术前通过泌尿系超声和静脉肾盂造影（ⅣP）明确病变程度、术后3个月进行复查了解恢复情况。结果12例患者均接受后腹腔镜输尿管成形术，手术过程顺利，术后无漏尿、感染、大出血等并发症发生。手术平均时间为43．9min（35-55min），术中预计失血量为12．4ml（5～20ml），术后留置引流管天数平均为2．9d（1～4d），术后首日引流量平均为41．7ml（20-75m1），术后留置尿管天数平均为4．3d（2～7d），术后住院天数平均为9．5d（6～13d），12例患者均于术后6周拔除双J管。术后3个月复查IVP显示输尿管扩张管径明显缩小、平均约0．55cm，术前有症状者均完全缓解。结论后腹腔镜输尿管成形术治疗下腔静脉后输尿管具有可靠的有效性和安全性，随访显示手术效果良好，结合相关文献报道结果，我们推荐采用后腹腔镜输尿管成形术治疗下腔静脉后输尿管。

Retroperitoneal laparoscopic ureteroplasty for retrocaval ureter

Objective To report on the treatment efficacy of retroperitoneal laparoscopic ureteroplasty for retrocaval ureter and summarize our experience. Methods 12 patients diagnosed with retrocaval ureter were included into the trial from Peking University First Hospital and Inner Mongolia Medical University Affiliated Hospital between March 2010 and December 2012, of which 5 cases were male and 7 cases were female. The average age was 22.3 years （range 13-34 years） with an average clinical course of 1.1 months. Urinary B-ultrasonography and intravenous pyelogram （IVP） were applied preoperatively and re-examined 3 months later after surgery. Results All patients were performed successfully by retroperitoneal laparoscopic ureteroplasty without blood transfusion and severe complications like urine leakage, infection or massive hemorrhage. The mean operative time was 43.9 min （range 35-55 min）, the estimated blood loss was 12.4 ml （range 5-20 ml）, the mean retroperitoneal drainage was 2.9 d （range 1-4 d）, the mean first-day draining volume was 41.7 rnl （range 20-75 ml）, the mean detaining urinary catheter was 4.3 d （range 2-7 d）, the mean postoperative hospitalization was 9.5 d （range 6-13 d）, and the double-J catheter was removed 6 weeks later after operation. When follow-up came, the examinations revealed that the expansive ureters were distinctly diminished to an average diameter of 0.55 cm. The symptoms were relieved completely. Conclusion Retroperitoneal laparoscopic ureteroplasty for retrocaval ureter is an effective, feasible and safe surgical procedure with promising results of the follow-up examination. It can be strongly recommended as an effective minimally invasive procedure for retrocaval ureter after reviewing relevant literatures.