摘要
目的探讨输尿管乳头插入法在腹腔镜输尿管膀胱再植术中的抗反流效果。方法对13例患者(14侧)实施乳头插入法腹腔镜输尿管膀胱再植术。将输尿管下段游离后经Trocar拖至体外,根据需要缩窄管腔,末端1 cm长管壁外翻反转缝合,形成输尿管乳头,插入双J管后回纳腹腔;于膀胱后侧壁取切口,将乳头及双J管一端插入膀胱,行膀胱壁全层与输尿管乳头下缘外膜缝合,将乳头完全植入膀胱。结果所有手术均顺利完成,术后膀胱镜检查及膀胱造影显示其中13侧无反流,镜检可见输尿管乳头突入膀胱0.8~1.0 cm,形态规则,无凹陷及萎缩,非喷尿时乳头黏膜闭合;1侧出现Ⅲ级反流,镜检可见乳头形态不规则,局部萎缩并凹陷,膀胱充盈过程呈持续张开状态。中位随访时间24个月(6~63个月),泌尿系超声均未发现输尿管扩张或肾积液有较术前加重的情况,患者未出现急性肾盂肾炎,无腰痛、腰胀等临床症状。结论乳头插入法在腹腔镜输尿管膀胱再植术中抗反流效果确切,植入过程操作简单,值得临床推广,但有许多技术环节尚需规范。
Objective To explore the anti-reflux effectiveness of direct ureteral nipple in laparoscopic ureteral reimplantation. Methods Thirteen patients（14 sides） underwent laparoscopic direct nipple ureteroneocystostomy. In each case, the lower end of the ureter was freed and delivered out of the peritoneal cavity through the ipsilateral trocar. Then the lateral ureter was tailored and folded back onto itself approximately 1 cm to make into nipple evaginated mode. A double-J stent was placed in the ureter and replaced in the abdomen. The posterolateral wall of bladder was opened.Then the nipple and double-J stent were placed into the bladder lumen and a mucosa-to-full thicknessanastomosis was made. Results Surgery was successful in all 13 patients. 13 sides monitored with cystourethrography and cystoscopy did not demonstrate vesicoureteral reflux. Cystoscopy revealed the intravesical nipple was 0.8-1.0 cm long. The shape of nipple was regular without depression and atrophy. But 1 case was revealed with third-degree reflux. Cystoscopy revealed the shape of nipple was irregular with partial depression and atrophy. The nipple remained open during the bladder-filling period. The median follow-up was 24 months（6-63 months）. No patients showed the improvement of hydronephrosis or ureterectasia on ultrasound. No patients occurred acute pyelonephritis or the symptom of backache.Conclusion Laparoscopic ureteral reimplantation with direct ureteral nipple shows effective anti-reflux effectiveness. It is relatively easy to operate during the process to implant the nipple and worthy of being widely applied in clinic. However, such technical issues need to be standardized.
出处
《中国医药导报》
CAS
2017年第21期74-77,共4页
China Medical Herald
基金
广东省科技计划项目(2012B061700035)
