腹腔镜Lich-Gregoir手术治疗儿童双侧原发性膀胱输尿管反流

目的 评价腹腔镜Lich-Gregoir手术治疗儿童双侧原发性膀胱输尿管反流治疗效果.方法 对2007年9月至2009年9月4例腹腔镜Lich-Gregoir手术治疗双侧原发性膀胱输尿管反流患儿的临床资料进行回顾性分析.结果 4例患儿,均因反复尿路感染收治.平均年龄6.5岁(5～8岁).男1例,女3例,排尿行膀胱尿道造影(VCUG)均提示双侧VUR,其中Ⅴ级2侧,Ⅳ级3侧,Ⅲ级3侧.二巯丁二酸(DMSA)肾图均证实存在一侧或双侧肾瘢痕.所有病例均经腹腔路径成功于膀胱外完成腹腔镜Lich-Gregoir手术.平均手术时间为200min(140～300min),术中无明显出血,术后平均住院时间6 d(5～7 d).平均随访18.5个月(6～30个月),所有患儿术后6个月VCUG复查证实膀胱输尿管反流均完全消失,无发热性尿路感染及新的肾瘢痕形成.1例患儿术后出现短期尿潴留,留置导尿1周后症状消失.结论 我们的初步经验显示腹腔镜Lich-Gregoir手术安全、有效、创伤小、术后恢复快,有望成为治疗儿童原发性膀胱输尿管反流,尤其是双侧病变较理想的治疗方法.

Laparoscopic Lich-Gregoir procedure for bilateral primary vesicoureteral reflux in children

Objective We reviewed the results of laparoscopic Lich-Gregoir procedure in children with bilateral primary vesicoureteral reflux(VUR). Methods Between September 2007 and September 2009, 4 children with bilateral primary VUR underwent laparoscopic extravesical reimplantation (Lich-Gregoir technique). The clinical data was retrospectively analyzed. Results All patients were referred to our clinic for recurrent urinary tract infection. The mean age of the patients was 6.5 years ( ranging from 5 to 8 years ), and there were 1 boy and 3 girls. Bilateral primary vesicoureteral reflux was confirmed by voiding cystourethrography (VCUG), including 2 sides with grade Ⅴ, 3 with grade Ⅳ and 3 with grade Ⅲ. Renal scars were assessed with dimercaptosuccinic acid (DMSA) scans.Four patients underwent transperitoneal laparoscopic Lich-Gregoir operations. All procedures were successfully completed laparoscopically. The mean operative time was 200 minutes ( ranging from 140 to 300 min). The blood loss was minimal. The mean hospital stay was 6 days (ranging from 5 to 7 days). The average follow-up period was 18.5 months ( ranging form 6 to 30 months). The disappearance of VUR was confirmed in all patients with VCUG 6 months post-operatively. There was no febrile urinary tract infections or new renal scarring post-operatively. There was transient urinary retention in 1 patient, but the symptom disappeared after catheterization for one week. Conclusions Laparoscopic transperitoneal Lich-Gregoir reimplantation for vesicoureteral reflux is a safe and effective approach.