目的 探讨腹腔镜输尿管膀胱再植术治疗膀胱输尿管反流(vesicoureteral reflux, VUR)的手术技巧与临床疗效。方法 2010-01至2014-06,北京军区总医院共收治膀胱输尿管反流9例,其中男4例,女5例,年龄16～43岁,平均(27.0±3.2)岁。所有患者均为单侧病变,3例为原发性反流,6例为继发性反流。所有患者均按照膀胱外黏膜下隧道法行腹腔镜输尿管膀胱再植术,术后随访。结果 9例手术均获成功,无中转开放。手术持续时间70～180 min,平均(117±27.5) min。术中出血量为20～60 ml,平均(36±12.4)ml。术后住院时间为4～9 d,平均(6.3±2.1)d。所有患者均无漏尿,1例术后发生膀胱痉挛,余患者无并发症。所有患者均获随访,随访时间9～36个月。术后3个月排泄性膀胱尿道造影提示Ⅰ级反流2例,术后半年Ⅰ级反流1例。术后所有患者输尿管、肾盂扩张情况均无进行性加重。结论 腹腔镜输尿管膀胱再植术具有创伤小、并发症少、恢复快等优势,是治疗VUR可选择的微创方法,具有较高的临床应用价值。
Abstract
Objective To furnish the experience and evaluate the efficacy of transperitoneal laparoscopic ureterovesical reimplantation for patients with vesicoureteral refux. Methods Nine patients with vesicoureteral refux undergoing transperitoneal laparoscopic ureterovesical reimplantation in this department from January 2010 to June 2014 were retrospectively analyzed. Among the patients, 4 were male, 5 were female, with the age of 16 to 43 and the mean age of 27. All lesions were unilateral, 3 lesions were primary reflux and 6 were secondary reflux. Results All the 9 patients were operated successfully without conversion to open surgery.The mean operation time was (117±27.5) min (range 70 to 180 min), mean blood loss was 36±12.4 ml (range 20 to 60 ml). The mean postoperative hospital stay was (6.3±2.1) days (range 4 to 9days). No urine leakage was found after operation. Perioperative complications included only 1 bladder spasm. All patients were followed up for 9 to 36 months, 2 patients had grade Ⅰ reflux at 3 months postoperation, at 6 months post operation , only 1 patients had grade Ⅰ reflux. Ultrasound revealed no progression of the dilation of the ureter and pelvis after operation. Conclusion With the advantages of minimal invasion, less complications and fast recovery, transperitoneal laparoscopic ureterovesical reimplantation is a feasible approach and can be safely performed for selected patients withvesicoureteral refux.
关键词
腹腔镜 /
输尿管膀胱再植术 /
膀胱输尿管反流
Key words
laparoscopic /
ureterovesical reimplantation /
vesicoureteral refux
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基金
国家自然科学基金青年科学基金项目资助(项目编号:81400701)
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