腹膜后腹腔镜输尿管成形术治疗腔静脉后输尿管（附4例报告）

目的探讨经腹膜后途径行腹腔镜输尿管成形术治疗下腔静脉后输尿管畸形的方法与疗效。方法 4例下腔静脉后输尿管患者均行腹膜后腹腔镜输尿管成形术,于扩张输尿管下端离断输尿管,移至腔静脉腹侧端端吻合,恢复正常解剖结构。结果 4例手术均成功,平均手术时间170（120-200）min,腹腔镜操作平均时间为150（105-180）min。无下腔静脉等邻近器官损伤,术中无明显出血,术后无漏尿发生,腰痛消失,3个月后复查示肾及输尿管上段积水扩张显著减轻,肾功能良好,吻合口无狭窄。结论经腹膜后腹腔镜输尿管成形术具有创伤小、疼痛轻、术后恢复快的优点,是治疗腔静脉后输尿管合并肾积水的首选方法 。

Retroperitoneoscopic Ureteroplasty for Retrocaval Ureter (A Report of 4 Cases)

Objective To investigate the method and effect of retroperitoneal laparoscopic ureteroplasty for retrocaval ureter.Methods 4 cases with retrocaval ureter were performed laparoscopic ureteroplasty by retroperitoneal approach.After dissociation of the dilated proximal ureter,the retrocaval segment was dissected and repositioned to the anterior of vena caval,and then a tension-free anastomosis was performed with several running sutures by 4-0 polyglactin.Normal anatomic structure was established after the operation.Results The ureteroplasty was accomplished successfully in all cases without adjacent organ or vessel injury.The mean operative duration was 170 minutes（ranged from 120 to 200 minutes）,and the laparoscopic operating time was 105 to 180 minutes（average 150 minutes）.No serious intraoperative hemorrhage and postoperative leakage of urine occurred.After 3 months＇ survey,the low back pain was disappeared,and hydronephrosis and dilating of upper ureter was significantly improved by ultrasonography.The renal function was restored normal,and no stenosis of anastomotic stoma was found.Conclusion Retroperitoneoscopic ureteroplasty should be recommended as the first choice for retrocaval ureter because of the advantages as mini-trauma,less pain and faster recovery.