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目的:探讨后腹腔镜输尿管端端吻合术治疗下腔静脉后输尿管的手术技巧和临床效果。方法:2006年1月～2011年12月间对9例下腔静脉后输尿管患者实施后腹腔镜输尿管端端吻合术,吻合方法采取两针固定连续缝合法,观察手术时间、出血量、引流管放置时间、住院时间、术后复查情况等,并总结其手术技巧。结果:9例手术均获成功。平均手术时间71.8(65～124)min,无一例中转开放手术。无下腔静脉等邻近脏器损伤。术中出血10～30ml;术后3～5天拔除引流管,无尿漏发生;5～7天拔除尿管;4～5周拔除输尿管支架管,平均住院7.5(7～10)d。9例患者均于出院3～6个月复诊,腰痛不适均缓解,尿常规和肾功能检查均正常,复查泌尿系B超均显示输尿管走行正常,6例肾积水较术前减轻,3例肾积水消失,吻合口无狭窄。结论:后腹腔镜输尿管端端吻合术治疗下腔静脉后输尿管安全可行;采用两针固定连续缝合法可提高手术效果,减少吻合口并发症的发生。
Objective: To investigate the surgical technique and clinical effect of retroperitoneal laparoscopic ureteral anastomosis in the treatment of ureter after IVC. Methods: From January 2006 to December 2011, 9 patients with posterior ureteral obstruction underwent retroperitoneal laparoscopic ureteroscopic anastomosis, and the anastomosis method was adopted two-needle fixed continuous suture method. The operative time, amount of bleeding, drainage tube Placement time, hospital stay, postoperative review of the situation, and summarizes the surgical skills. Results: All the 9 surgeries were successful. The average operative time was 71.8 (65-124) min, with no open surgery. No inferior vena cava and other adjacent organs damage. Intraoperative bleeding 10 ~ 30ml; 3 to 5 days after removal of the drainage tube, no urine leakage occurred; 5-7 days removal of the catheter; 4 to 5 weeks removal of ureteral stent tube, the average hospitalization 7.5 (7 ~ 10) d. All 9 patients were followed up for 3 to 6 months after discharge. The patients with low back pain were relieved. Urine routine examination and renal function tests were normal. All the urinary tract ultrasonography showed that the ureter went normal. The hydronephrosis in 6 patients was relieved preoperatively and 3 Hydronephrosis disappeared, anastomotic stenosis. Conclusions: Retroperitoneal laparoscopic ureteral end-to-end anastomosis is safe and feasible for the treatment of ureter after IVC. The use of two-needle continuous suture can improve the surgical results and reduce the incidence of anastomotic complications.