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【目的】探讨采用自制多通道套管和常规器械经脐行腹腔镜下乳头式输尿管膀胱再植术的可行性和疗效。【方法】2009年4月至2009年12月对9例输尿管末端狭窄或异位开口的患者行腹腔镜输尿管膀胱再植术。气管内全麻下经脐部切口置入自制多通道套管(用手套和两个弹性橡胶环制作而成)。从髂血管分叉处找到并游离异常输尿管至膀胱壁段处切断,末端1cm纵行切开外翻缝合形成乳头,输尿管内置双J管,从膀胱后顶部切口插入膀胱约1～1.5cm,4-0可吸收线间断吻合6针,检查无渗漏后放置盆腔引流。【结果】全部手术均在单孔腹腔镜下成功完成,无需术中增加套管或开放手术。平均手术时间为87min,平均估计失血量小于30mL,无术中并发症发生,术后1d可起床活动,引流管、尿管、双J管分别在2d、7d、30d拔除,内镜下可见输尿管乳头,术后2～3月静脉尿路造影(IVU)及膀胱尿道造影未见吻合口狭窄和反流,脐部切口美观。【结论】经脐单孔腹腔镜下输尿管膀胱再植术具有创伤小、美观经济、恢复快的优点。输尿管乳头式膀胱再植法狭窄率低、抗反流效果好,镜下操作简便,值得推广应用。
【Objective】 To investigate the feasibility and efficacy of laparoscopic papillary ureter bladder replantation using homemade multi-channel cannula and conventional instruments. 【Methods】 From April 2009 to December 2009, laparoscopic ureteral bladder replantation was performed in 9 patients with ureteric stenosis or ectopic opening. Tracheal anesthesia through the umbilical incision into the homemade multi-channel cannula (made of gloves and two elastic rubber ring made). From the iliac vascular bifurcation found and free from the abnormal ureter to the bladder wall segment cut off the end of the 1cm longitudinal incision suture to form a nipple, ureter built double J tube, from the top of the bladder incision into the bladder about 1 ~ 1.5cm, 4 -0 absorbable line intermittent anastomosis 6-pin, check the leak-free pelvic drainage. 【Results】 All the operations were successfully completed in one-hole laparoscopic surgery without the need of cannulation or open surgery. The mean operative time was 87 min. The mean blood loss was estimated to be less than 30 mL. There was no intraoperative complications and the activity was recovered on the first postoperative day. The drainage tube, catheter and double J tube were removed at 2 days, 7 days and 30 days respectively. Nipple, 2 to 3 months after intravenous urography (IVU) and cystocele did not anastomotic stenosis and reflux, umbilical incision beautiful. 【Conclusion】 Umbilical single hole laparoscopic ureter bladder replantation has the advantages of less trauma, beautiful economy and quick recovery. Ureter papillary bladder replantation stenosis rate is low, anti-reflux effect is good, easy to operate under the microscope, it is worth to promote the application.