论文部分内容阅读
目的介绍应用气膀胱腹腔镜(pneumovesicoscopy)行Cohen输尿管移植术的体会。方法2002年11月~2004年12月治疗11例患儿,年龄3个月~11岁,平均4.4岁。男5例,女6例。膀胱输尿管反流8例(双侧3例、重复肾重复输尿管反流1例),输尿管末端狭窄输尿管全程扩张2例,重复肾上半肾积水输尿管扩张输尿管囊肿1例,总共16根输尿管。手术方法:经膀胱镜注CO2气体扩张膀胱,膀胱镜观察下在脐下以带针缝线经皮穿透膀胱全层做牵引线,鞘管(trocar)沿牵引线穿刺插入膀胱与牵引线固定。同法两侧放置操作鞘管。经中线鞘管目镜观察,两侧鞘管操作。同开放手术行Cohen输尿管移植。术后不放输尿管支撑管仅留置导尿管。结果11例手术均获得成功,无中转开放。手术时间120~300min,平均213min。术后5~7d拔除导尿管出院。术后随访2~14个月,10例无尿路感染发生,尿常规检查正常,其中3例随访,MCU检查原4~5级反流消失。1例出现吻合口狭窄伴尿路感染,予保守治疗控制感染成功。结论在熟练掌握腹腔镜分离缝合技术基础上,气膀胱腹腔镜手术行Cohen输尿管移植术可取得良好的手术效果。
Objective To introduce the experience of Cohen ureter transplantation under pneumovesicoscopy. Methods From November 2002 to December 2004, 11 children were treated, ranging in age from 3 months to 11 years with an average of 4.4 years. 5 males and 6 females. 8 cases of vesicoureteral reflux (bilateral in 3 cases, repeated ureteral reflux in 1 case), distal ureteral stricture ureteral expansion in 2 cases, repeated upper kidney hydronephrosis in 1 case of ureterocele, a total of 16 ureters. Surgical methods: CO2 gas cystoscopy expansion bladder, under cystoscopy observed under the umbilical needle with suture to do full-thickness bladder through the traction line, the sheath (trocar) along the traction line inserted into the bladder and traction line fixation . Place the sheath on both sides of the same method. The midline sheath eyepiece, both sides of the sheath operation. Cohen ureter transplantation with open surgery. Postoperative ureteral support tube indwelling catheter only. Results All the 11 surgeries were successful and no transit was found. Surgery time 120 ~ 300min, an average of 213min. 5 ~ 7d after removal of the catheter discharge. The patients were followed up for 2 to 14 months. Ten cases had no urinary tract infection and their urinalysis was normal. Among them, 3 cases were followed up and the original 4 ~ 5 grade reflux disappeared after MCU examination. One case of anastomotic stenosis with urinary tract infection, conservative treatment to control infection was successful. Conclusions On the basis of proficiency in laparoscopic suture technique, Cohen ureter transplantation under laparoscopic pneumoperitoneum can achieve good surgical results.