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目的 探讨腹腔镜输尿管膀胱再植术的可行性及其临床意义。 方法 男 5例 ,女 12例。左侧 7例 ,右侧 10例。 10例为单纯先天性输尿管出口狭窄 ;1例右侧输尿管出口结石和息肉形成 ;2例为开放输尿管膀胱再植术后再发输尿管出口狭窄 ,其中 1例并发输尿管下端 2枚结石 ;1例为重复肾输尿管上单位输尿管出口狭窄并发 2枚结石 ;2例为输尿管出口狭窄作经尿道钬激光切开再次狭窄 ;1例为泌尿系结核左肾切除术后右侧输尿管出口狭窄。重度肾积水 12例 ,中度肾积水 5例。均应用腹腔镜输尿管膀胱再植术治疗 ,其中输尿管膀胱黏膜吻合术 15例 ,膀胱壁袢法 2例。 结果 17例均获得成功。手术耗时 90～ 16 0min ,平均 112min ,术中出血 6 0～ 10 0ml。术后 1～ 3d拔除膀胱外引流管 ,无 1例尿漏 ,术后 1周拔除导尿管 ,术后 1个月拔除双J管。 1例因上尿路结石下移至输尿管膀胱吻合口再次形成梗阻 ,行体外冲击波碎石 (ESWL)治疗 ,无吻合口狭窄。术后半年膀胱造影Ⅲ°输尿管返流 6例 ,Ⅰ°～Ⅱ°输尿管返流 5例 ,无输尿管返流 6例 ;术后 1年Ⅲ°输尿管返流 3例 ,Ⅰ°～Ⅱ°输尿管返流 4例。随访 3～ 2 4个月 ,B超和IVU复查中度肾积水 4例 ,轻度肾积水 5例 ,无明显肾积水 8例。 结论 腹腔镜输尿管膀胱再植术可行 ,输尿管膀
Objective To investigate the feasibility and clinical significance of laparoscopic ureteral bladder replantation. Methods Male 5 cases, female 12 cases. Left in 7 cases, right in 10 cases. 10 cases were simple congenital ureter export stenosis; 1 case of right ureter exit calculus and polyp formation; 2 cases of open ureteral bladder replantation ureter export stenosis, 1 case complicated by ureteral lower two stones; 1 case of Two ureteral ureteral ureteral stricture exit accompanied by two stones; two cases of ureteral outlet stenosis by transurethral holmium laser re-stenosis; one case of urinary tuberculosis left nephrectomy after the right ureter export narrow. 12 cases of severe hydronephrosis, moderate hydronephrosis in 5 cases. All of them were treated with laparoscopic ureteric bladder replantation, including 15 cases of ureter and bladder mucosa anastomosis and 2 cases of bladder wall stenosis. Results 17 cases were successful. Surgery time-consuming 90 ~ 16 0min, an average of 112min, intraoperative bleeding 60 ~ 10ml. One to three days after operation, the extrauterine drainage tube was removed without urinary leakage. The catheter was removed one week after operation and the double J tube was removed one month after operation. One case of upper urinary tract stones down to the ureterovesical anastomotic re-formation of obstruction, extracorporeal shock wave lithotripsy (ESWL) treatment, no anastomotic stenosis. Six months after operation, 6 cases had cystography Ⅲ ° ureter reflux, 5 cases had Ⅰ ° ~ Ⅱ ° ureteral reflux, 6 cases had no ureteral reflux, 1 case had Ⅲ ° ureter reflux in 3 cases and Ⅰ ° ~ Ⅱ ° ureter returned Flow in 4 cases. All cases were followed up for 3 to 24 months. Four cases of moderate hydronephrosis and 5 cases of mild hydronephrosis were examined by B-ultrasound and IVU. There was no obvious hydronephrosis in 8 cases. Conclusions Laparoscopic ureteric vesicle replantation is feasible and ureter bladder