摘要
目的：评价倒刺线连续缝合法在耻骨上辅助经脐单孔腹腔镜（SA-LESS）插入式输尿管膀胱再植术中的应用价值。方法：2012年1月～2014年9月实施SA-LESS插入式输尿管膀胱再植术21例，男9例，女12例。输尿管末端狭窄16例，巨输尿管症2例，输尿管阴道瘘2例，重复输尿管异位开口1例。左侧14例，右侧7例。患者全麻，取平卧头低脚高位。分别于脐缘置入10mm、5mm Trocar及操作器械，健侧耻骨联合上阴毛覆盖区置入5mm套管及5．4Mm 0°远端可弯曲腹腔镜。游离输尿管下段，于病变近端切断。输尿管内留置双J管，切开膀胱侧后顶壁，行插入式输尿管膀胱再植。按吻合方法不同分为两组，A组11例采用新型双向带倒刺缝合线行连续缝合，B组10例采用单针薇荞线行间断缝合。结果：21例21侧手术均顺利完成，无大出血、尿瘘、腹腔感染等严重并发症发生。A组手术时间、术中输尿管膀胱吻合时间均低于B组（P〈O．01）。两组术中出血量、术后引流管留置时间、肠道功能恢复时间、并发症发生率等差异无统计学意义（P〉0．05）。随访3～36个月，患侧肾输尿管积水好转或消失，无膀胱输尿管反流、吻合口狭窄发生。结论：SA-LESS插入式输尿管膀胱再植术安全、有效，美容效果佳；术中应用倒刺线连续缝合，无需打结，显著降低了操作难度，缩短了手术时间，值得临床推广应用。
Objective ： To evaluate the value of continuous self-retaining suture （QUILL SRS） in suprapubic-as- sisted laparoendoscopic single-site surgery （SA-LESS） for inserting ureteral reimplantation. Method：From January 2012 to September 2014, 21 cases including 9 males and 12 females underwent SA-LESS inserting ureteral reim- plantation. Among them, distal ureter stricture existed in 16 cases, megaureter in 2 cases, uretero-vaginal fistula in 2 cases, repeat ectopic ureter in 1 case. There were 14 cases on the leit side, 7 cases on the right side. Under general anesthesia, the patients were placed in Trendelenburg position. One 5- and 10-ram trocars were inserted into the umbilical edge. A 5-ram trocar was inserted into abdominal cavity below the pubic hairline, through which a 5.4-ram 0~ flexible-tip laparoscope was placed. The ureter was resected at the upper obstruction, and was reim- planted into the bladder directly with the terminal in the bladder at 1-1.5 cm length. According to the method of anastomosis, the patients were divided into two groups （A~ 11, B= 10）. Patients in group A underwent continu- ous suture with QUILL SRS, and those in group B underwent interrupted suture with Vicryl suture. Result：Twen-ty one procedures were completed successfully without complications such as massive haemorrhage, urinary fistula or serious abdominal infection. The time of operation and ureteroeystoneostomy in group A was shorter than that of group B （P〈0.01）. There was no statistically significant difference in the intraoperative estimated blood loss, postoperative drainage tube indwelling time, intestinal function recovery time, or rate of complication between the two groups （P〉0.05）. During the follow-up period of 3-36 months, hydronephrosis disappeared or reduced, and no ureter stenosis or reflux occurred. Conclusion： SA-LESS inserting ureteral reimplantation is safe and effective. The technique of continuous suture with QUILL SRS can make operation easier, reduce operative time signific
出处
《临床泌尿外科杂志》
2015年第5期400-403,411,共5页
Journal of Clinical Urology
基金
国家高技术研发计划(863计划)项目(编号2012AA021100)
江西省"赣鄱英才555工程"领军人才培养计划项目
江西省科技厅重大科技支撑计划项目(编号20121BBG70032
20132BAB205007)
江西省卫生厅重大科技计划项目(编号20104008)
江西省教育厅科技落地计划项目(编号KJLD12044)
关键词
腹腔镜术
单孔
耻骨联合
输尿管膀胱吻合
可吸收缝线
laparoendoscopy
single-site
pubic symphysis
ureterocystoneostomy
absorbable suture
