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目的:探讨输尿管开口异位患者经腹腹腔镜膀胱外乳头式输尿管膀胱再植术的可行性和临床效果。方法:对10例输尿管开口异位患者均采用经腹腹腔镜膀胱外乳头式输尿管膀胱再植术。全麻,仰卧位患侧抬高,建立腹腔镜工作通道(经肚脐5mm Trocar,经腹直肌外侧缘左侧5mm/10mm Trocar,右侧12mm Trocar),充分游离患侧扩张输尿管,注意保护同侧正常输尿管,于靠近膀胱处离断异位开口输尿管,自同侧Trocar切口拉出腹壁,体外裁剪输尿管至大致正常直径,5/0可吸收线缝合输尿管管壁,末端制成乳头状,置入双J管后回纳腹腔;于膀胱底部后壁做全层切口,将输尿管末端乳头及双J管插入膀胱内,使用5/0可吸收线于膀胱全层与输尿管浆肌层间断吻合6~8针,吻合结束后膀胱注水测试有无漏尿,放置引流管及尿管。结果:10例手术均获成功,手术耗时90~160min,术中出血30~50ml,术后4~6天拔引流管,7~10天拔除尿管,术后1个月拔除双J管。术后随访1~11个月阴道无漏尿,尿常规正常,B超示肾积水减轻或消失。结论:重复肾输尿管开口异位患者经腹腹腔镜膀胱外乳头式输尿管膀胱再植是可行性的,临床效果等同于开放手术,且具有创伤小、恢复快、手术瘢痕基本不可见的优点。
Objective: To investigate the feasibility and clinical effect of transabdominal laparoscopic papillary ureter bladder replantation in patients with ureteral ectopic. Methods: Ten cases of ureteral open ectopic patients were treated with transabdominal laparoscopic papillary ureteral bladder replantation. General anesthesia, supine ipsilateral elevation, the establishment of laparoscopic working channel (via the navel 5mm Trocar, via the rectus abdominis lateral left 5mm / 10mm Trocar, right 12mm Trocar), fully free ipsilateral dilation of the ureter, pay attention to the protection of the same Side of the normal ureter, in the vicinity of the bladder off the ectopic opening of the ureter, from the same side of the Trocar incision out of the abdominal wall, cut the ureter to approximately normal diameter, 5/0 absorbable suture the ureteral wall, the tip made of papillary, Into the double J tube after the return of the abdominal cavity; at the bottom of the bladder to make full-thickness incision, the end of the ureter and double J tube inserted into the bladder, the use of 5/0 absorbable line in the bladder full-thickness ureter with intermittent anastomosis 6 ~ 8-pin, anastomosis after the bladder water test for leakage, placed drainage tube and catheter. Results: All the 10 surgeries were successful. The operation time was 90 ~ 160min. The intraoperative hemorrhage was 30 ~ 50ml. The drainage tube was drained 4 ~ 6 days after operation. The catheter was removed 7 ~ 10 days after operation. The double J tube was removed 1 month after operation. . Postoperative follow-up 1 to 11 months without leakage of urine in the vagina, urinary routine, B ultrasound showed hydronephrosis reduced or disappeared. Conclusion: Laparoscopic transurethral papillary ureteropy replantation is feasible in patients with ectopic ureteropelvic duplication. The clinical effect is equivalent to open surgery, and has the advantages of less trauma, faster recovery and scarless surgical scar.