摘要
目的总结气膀胱腹腔镜下Politano-Leadbetter输尿管移植术的经验。方法回顾性分析厦门市妇幼保健院小儿外科2018年1月至2018年7月收治的10例输尿管膀胱连接部异常患儿临床资料,患儿均采用气膀胱腹腔镜下Politano-Leadbetter术治疗。其中男童6例,女童4例;年龄1.76~24个月,平均6.9个月。膀胱输尿管连接部狭窄4例,右侧2例,左侧2例;膀胱输尿管反流6例,单侧2例,双侧4例。手术方法:常规建立气膀胱,膀胱镜下置入腹腔镜及操作器械,膀胱内游离输尿管后,应用尿道口-输尿管开口-新输尿管裂孔三点一线原理,准确寻找膀胱外输尿管。自新的裂孔将输尿管重新迁入膀胱,再向原输尿管口建立黏膜下隧道。结果10例均经气膀胱下完成手术,无一例中转开放手术。单侧手术时间100~185 min,平均131 min;双侧手术时间115~205 min,平均174 min。术中几乎无明显出血。术后8 d拔除尿管后无一例出现排尿困难、切口感染和切口裂开,住院时间7~15 d。10例均获随访,随访时间6~12个月,均无尿漏、膀胱输尿管反流、输尿管膀胱连接部梗阻等并发症发生。结论气膀胱腹腔镜下行Politano-Leadbetter术成功率高,能保留原始输尿管的开口位置与解剖走向,是小儿输尿管移植术可行的微创手术方式。
Objective To review our institutional experience of pneumocystoscopic Cohen ureteric reimplantation.Methods Retrospective analysis was performed for clinical data of 10 children with congenital malformation of vesicoureteral junction undergoing pneumoeystoscopic Politano-Leadbetter reimplantation between January 2018 and July 2018.There were 6 boys and 4 girls with a mean age of 6.9(1.76-24)months.There were congenital vesicoureteral junction obstruction(n=4)(2 left,2 right)and vesicoureteral reflux(n=6)(2 unilateral,4 bilateral).Confirmation was made by voiding cystourethrography.A trocar was inserted into bladder after carbon monoxide was insufflated into bladder through cystoscope.Another 2 trocars were inserted laterally in the same way.Politano-Leadbetter procedure was performed through the lateral trocars.Three-point and one-line principle of urethral opening-ureter opening-new ureteric rupture were employed for accurately locating extraurethral ureter.Ureter was relocated to bladder from a new hole,and a submucosal tunnel is established to the original ureteral orifice.Results All patients underwent pneumoeystoscopic Politano-Leadbetter reimplantation successfully.The mean operative duration was 131(100-185)min for unilateral cases and 174(115-205)min for bilateral cases.There was no dysuria,incisional infection or incisional dehiscence after a removal of urinary catheter.During a follow-up period of 6-12 mouths,there was no occurrence of such complications as fistula,vesicoureteral reflux or vesicoureteral junction obstruction.Conclusion Pneumoeystoscopic Politano-Leadbetter reimplantation simplifies operation course.Preserving a longitudinal ureter similar to physiological state,it is an excellent mini-invasive surgery for pediatric ureteral transplantation.
作者
徐延波
陈海琛
马丽丽
胡杨
吴永隆
Xu Yanbo;Chen Haichen;Ma Lili;Hu Yang;Wu Yonglong(Department of Pediatric Surgery,Municipal Maternal&Children's Health Hospital,Xiamen 361003,China)
出处
《临床小儿外科杂志》
CAS
2020年第8期741-745,758,共6页
Journal of Clinical Pediatric Surgery
