腹腔镜膀胱肌瓣代输尿管术治疗长段输尿管狭窄的初步体会

发布时间：2018-06-15 07:58

本文选题：输尿管狭窄 + 腹腔镜　；参考：《中国内镜杂志》2017年04期

【摘要】：目的探讨腹腔镜膀胱肌瓣代输尿管术治疗中、下段输尿管长段狭窄的可行性与重建方法。方法回顾性分析2014年5月-2016年4月该科在腹腔镜下应用膀胱肌瓣代输尿管术治疗中、下段长段输尿管狭窄患者3例临床资料。男1例,女2例,2例有输尿管中、下段结石输尿管镜手术史,1例有输尿管结石反复体外冲击波碎石(ESWL)史。术前泌尿系B超、CT、静脉肾盂造影显示患侧肾脏重度积水,输尿管中、上段重度扩张,中、下段严重狭窄。结果 3例患者手术顺利,成形后的膀胱肌瓣管平均长度约9.6 cm,平均手术时间180 min,平均住院时间10 d,术后8周顺利拔除双J管,拔管时输尿管镜检查吻合口通畅,能顺利通过8.5 F输尿管镜,无感染及尿漏发生。术后随访3~18个月,泌尿系彩超提示3例患者上尿路积水显著减轻,静脉肾盂造影显示输尿管通畅,输尿管与肌瓣管连接处无狭窄,血肌酐值均在正常范围。结论腹腔镜膀胱肌瓣代输尿管术是治疗中、下段输尿管长段狭窄的有效方法,但术者需具备丰富的腹腔镜手术经验。
[Abstract]:Objective to investigate the feasibility and reconstruction method of laparoscopic bladder muscle flap replacement ureter in the treatment of distal ureteral long segment stenosis. Methods from May 2014 to April 2016, the clinical data of 3 patients with lower long ureteral stenosis treated with bladder muscle flap replacement ureter under laparoscope were retrospectively analyzed. The history of ureteroscopy was found in 1 case of ureteral calculi and 2 cases of female. The history of ureteroscopic lithotripsy was found in 1 case of ureteral calculi with repeated extracorporeal shock wave lithotripsy (ESWL). Before operation, CT and intravenous pyelography showed severe hydronephrosis, severe dilatation of the middle and upper ureter and severe stenosis of the middle and lower segments of the ureter. Results the operation was successful in 3 patients. The average length of bladder muscle valve was about 9.6 cm, the average operation time was 180 min, the average hospitalization time was 10 days, and the double J tube was successfully removed 8 weeks after operation. The anastomotic stoma was unobstructed by ureteroscope during extubation. Successful passage of 8.5 F ureteroscopy, no infection and urinary leakage. Follow up for 3 ~ 18 months showed that the upper urinary tract hydronephrosis was significantly reduced in 3 patients. Intravenous pyelography showed that the ureter was patency, there was no stenosis between the ureter and the muscular valve, and the serum creatinine values were in the normal range. Conclusion Laparoscopic bladder muscle flap replacement of ureter is an effective method in the treatment of lower ureteral long segment stenosis.
【作者单位】：皖南医学院第二附属医院泌尿外科;
【分类号】：R699.4

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