摘要
【目的】探讨采用自制多通道套管和常规器械经脐行腹腔镜下乳头式输尿管膀胱再植术的可行性和疗效。【方法】2009年4月至2009年12月对9例输尿管末端狭窄或异位开口的患者行腹腔镜输尿管膀胱再植术。气管内全麻下经脐部切口置入自制多通道套管(用手套和两个弹性橡胶环制作而成)。从髂血管分叉处找到并游离异常输尿管至膀胱壁段处切断,末端1cm纵行切开外翻缝合形成乳头,输尿管内置双J管,从膀胱后顶部切口插入膀胱约1～1.5cm,4-0可吸收线间断吻合6针,检查无渗漏后放置盆腔引流。【结果】全部手术均在单孔腹腔镜下成功完成,无需术中增加套管或开放手术。平均手术时间为87min,平均估计失血量小于30mL,无术中并发症发生,术后1d可起床活动,引流管、尿管、双J管分别在2d、7d、30d拔除,内镜下可见输尿管乳头,术后2～3月静脉尿路造影(IVU)及膀胱尿道造影未见吻合口狭窄和反流,脐部切口美观。【结论】经脐单孔腹腔镜下输尿管膀胱再植术具有创伤小、美观经济、恢复快的优点。输尿管乳头式膀胱再植法狭窄率低、抗反流效果好,镜下操作简便,值得推广应用。
【Objective】To evaluate the feasibility and effect of laparoscopic surgery of ureterovesical reimplantation through transumbilical single-port access using homemade multichannel cannula with conventional laparoscopic instruments.【Method】Between April 2009 and December 2009,9 patients with ureter end stricture or ectopic orifice were performed single-port laparoscopic surgery of ureterovesical reimplantation.The multichannel port made of glove and two elastic rubber rings was inserted transumbilically under general anesthesia.The abnormal ureter was mobilized from common iliac artery branches to the bladder.The 1 cm of ureter end was opened longitudinally and formed split nipple.Double J stent was inserted into the ureter.The ureteral split nipple was inserted into the bladder at the posterior vertex of the bladder and fixed by interrupted suture with 4-0 absorbable suture.The drainage tube was put into the pelvic after the ureterovesical anastomosis was watertight.【Result】All procedures were completed successfully without application of additional ports or conversion to open surgery.The mean operative time was 87 min.The mean estimated blood loss was less than 30 mL.None of complications occurred perioperatively.The patients were ambulant in 1 day after operation.Drainage tube,catheter and double J stent were removed in 2,7,and 30 days postoperatively,respectively.Split nipple was observed under endoscopy one month postoperatively.Postoperative intravenous urography and cystourethrography in 2 or 3 months showed no stricture or reflux of ureterovesical anastomosis.Umbilical cosmetic results achieved.【Conclusion】Transumbilical single-port laparoscopic ureterovesical reimplantation is safe and feasible with minimal invasion,cosmetic benefits,less costs and rapid rehabilitation.Ureterovesical reimplantation with split nipple method have advantages with less stricture,antireflux effect,easy manipulation under laparoscope.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2010年第3期448-450,共3页
Journal of Sun Yat-Sen University:Medical Sciences
基金
国家自然科学基金(30500507
30672092)
教育部博士点基金(20060558027)
广东省自然科学基金(6104605
07117366
5001758)
关键词
腹腔镜
单孔系统
输尿管膀胱再植术
脐
laparoscopy
single port system
ureterovesical reimplantation
umbilical cord
