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目的:探讨腔静脉后输尿管的最佳治疗方式。方法:回顾性分析21例腔静脉后输尿管患者的治疗方法:14例行传统开放手术,其中1例行右肾切除术;3例行后腹腔镜下输尿管复位矫形术;4例行经腹腔手术,其中3例行腹腔镜下输尿管复位矫形术,1例行腹腔镜辅助下肾盂癌根治术。结果:21例手术均获成功。输尿管复位矫形术的开放组、后腹腔镜组和腹腔镜组平均手术时间分别为1.5 h、3.6 h和2.1 h;术中出血量分别为150ml、80 ml和70 ml;平均术后住院时间分别为7.5天、5天和6天。未出现围术期并发症。术后4～6周拔除双J管。随访6个月～4年,B超和(或)IVP复查无吻合口狭窄,输尿管梗阻均明显缓解。16例术前有右腰酸胀不适感症状者完全缓解。结论:采用腹腔镜下输尿管复位矫形术治疗腔静脉后输尿管应成为临床首选方式。经腹腹腔镜较后腹腔镜在腔静脉后输尿管段粘连严重的治疗和手术视野方面有一定优势。
Objective: To explore the best treatment of the ureter after vena cava. Methods: A retrospective analysis of 21 cases of retroperitoneal ureter in patients with treatment: 14 cases of conventional open surgery, including 1 case of right nephrectomy; 3 cases of laparoscopic ureteral reduction orthosis; 4 cases of transabdominal surgery , Of which 3 cases of laparoscopic ureteral reduction orthopedics, 1 case of laparoscopic assisted radical nephroureterectomy. Results: All the 21 surgeries were successful. The average operation time of open ureter, open laparoscopic group and laparoscopic group were 1.5 h, 3.6 h and 2.1 h respectively. The mean intraoperative blood loss was 150 ml, 80 ml and 70 ml, respectively. The average postoperative hospital stay was 7.5 days, 5 days and 6 days. No perioperative complications occurred. After 4 to 6 weeks to remove double J tube. All the patients were followed up for 6 months to 4 years. There was no anastomotic stenosis and ureteral obstruction in B-ultrasound and / or IVP was significantly relieved. 16 cases of right lower back pain and soreness symptoms were completely relieved. Conclusion: Laparoscopic ureteral reposition orthopedic surgery for the treatment of ureter after vena cava should become the preferred method of clinical. Laparoscopic laparoscopic retroperitoneal laparoscopic posterior ureteral adhesions serious surgical treatment and surgical vision has some advantages.