腹腔镜膀胱肌瓣代输尿管术治疗长段输尿管狭窄的初步体会

摘要： 目的??探讨腹腔镜膀胱肌瓣代输尿管术治疗中、下段输尿管长段狭窄的可行性与重建方法。方法?回顾性分析2014年5月-2016年4月该科在腹腔镜下应用膀胱肌瓣代输尿管术治疗中、下段长段输尿管狭窄患者3例临床资料。男1例，女2例，2例有输尿管中、下段结石输尿管镜手术史，1例有输尿管结石反复体外冲击波碎石（ESWL）史。术前泌尿系B超、CT、静脉肾盂造影显示患侧肾脏重度积水，输尿管中、上段重度扩张，中、下段严重狭窄。结果?3例患者手术顺利，成形后的膀胱肌瓣管平均长度约9.6 cm，平均手术时间180 min，平均住院时间10 d，术后8周顺利拔除双J管，拔管时输尿管镜检查吻合口通畅，能顺利通过8.5 F输尿管镜，无感染及尿漏发生。术后随访3～18个月，泌尿系彩超提示3例患者上尿路积水显著减轻，静脉肾盂造影显示输尿管通畅，输尿管与肌瓣管连接处无狭窄，血肌酐值均在正常范围。结论?腹腔镜膀胱肌瓣代输尿管术是治疗中、下段输尿管长段狭窄的有效方法，但术者需具备丰富的腹腔镜手术经验。
Abstract: Objective?To explore the effect of bladder muscle flaps for long segment defect of ureter middle-lower segment and reconstruction method in laparoscopic surgery.?Methods?Clinical data of 3 patients with long segment defect of ureter middle-lower segment, all of whom underwent laparoscopic surgery from May 2014 to April 2016 was retrospectively evaluated. There were 1 male and 2 females, in 2 cases with history of ureteroscopy holmium laser lithotripsy in ureter middle-lower segment, in 2 cases with history of repeated ESWL. Preoperative urinary tract ultrasound, CT and intravenous urography imaging showed severe hydronephrosis, ureter middle-upper segment severe hydroureter, ureter middle-lower segment severe stricture.?Results?Operations were successful in 3 cases. After reconstruction bladder muscle flaps average length of is 9.6 cm, The average operation time of 180 min, The average length of hospital stay for 10 d, Postoperative eighth weeks extracted the double J tube and used ureteroscopy showed anastomotic unobstructed, it may smooth Through 8.5 F ureteroscopy, and no infection and urinary leakage occurred, Follow-up ranged from 3 to 18 months. 3 cases hydronephrosis and hydroureter significantly reduce, ureter unobstructed, no narrow in ureter and muscle flap of tube joint, serum creatinine values were in normal range.?Conclusions?The bladder muscle flaps for the treatment of long segment defect of ureter middle-lower segment in laparoscopic surgery was a safe and effective therapy, but it must be accomplished by seasoned doctors.