气膀胱腹腔镜Cohen输尿管移植手术体会

目的 探讨气膀胱腹腔镜治疗膀胱输尿管连接处疾病的手术技巧.方法 回顾分析27例患儿的临床资料,其中输尿管远端狭窄12例(双侧2例,其中伴输尿管囊肿1例),原发性膀胱输尿管反流Ⅳ°-Ⅴ°共15例(双侧4例),共33根输尿管.在膀胱镜引导下注入CO2,建立气膀胱,经膀胱顶置入5mm目镜鞘管并固定,两侧放置3mm操作鞘管.膀胱内操作同开放Cohen手术,放置双J管,术后留置导尿3-5d.结果 27例气膀胱下完成手术,无中转开放手术.所有病例手术时间75-280min.术后轻度血尿13例,均在2d内消失.术后2周-1个月经尿道膀胱镜拔除双J管.随访3-12个月,VCU检查2例出现膀胱输尿管返流,无泌尿系感染.结论 CO2气膀胱下经膀胱内腹腔镜Cohen手术治疗膀胱输尿管连接处疾病安全有效,易操作,具有微创优势.

Experience of intravesical laparoscopic in treatment for Cohen unteric reimplantation

Objective To report our experience of intravesical laparoscopic Cohen ureteral reimplantation under carbon dioxide bladder insufflation for 27 patients with vesicoureteral malformations.Methods We analyzed 27 cases(18 boys and 9 girls,aged from 6 months to 9 years) vesicoureteral malformations.In all the patients,15 cases suffered from vesicoureteral reflux(4 in bilateral sides),12 with vesicoureteral junction obstruction(2 in bilateral sides,1 complicated with ureterocele).A trocar(5mm) was inserted into the bladder after CO2 was insufflated to the bladder under cystoscope show.Other 2 trocars(3mm) were inserted laterally.Laparoscopic procedures were identical as the open operation.The double J ureteral stent was placed.And postoperatively,a Foley catheter was inserted to drainage during five to seven days postoperatively.Results All procedures were completed without open operation.The duration of operations ranged from 75 mins to 280 mins.All patients were followed up from 3 to 12 months,2 patients have vesicoureteral reflux,and there are no the urinary tract infection was successfully controlled by anti-infectious treatment.Conclusion The intravesical laparoscopic Cohen ureteric reimplantation is satisfy,effective and could be possesd lightly.