六针缝合法在腹腔镜下插入式输尿管膀胱再植术中的应用

Inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture

摘要:

目的??探讨六针缝合法腹腔镜下插入式输尿管膀胱再植术的安全性及有效性。方法 回顾性分析2012年3月-2015年9月16例腹腔镜下6（4+2）针缝合法插入式输尿管膀胱再植术的手术视频、临床资料。统计分析手术时间、术中出血量、术后引流量、引流管拔除时间、术后住院时间以及术后输尿管反流、狭窄等并发症发生率。结果 16例手术顺利完成，无中转开放病例。手术时间60～125 min，平均85 min。术中出血量20～50 ml，平均32 ml。术后引流量60～400 ml，平均106 ml。引流管拔除时间3～6 d，平均4.2 d。术后住院时间7～10 d，平均8.5 d。16例均获随访，随访时间6～18个月，平均12个月。无吻合口狭窄病例，1例有轻度反流，随访18个月未见加重。结论 六针缝合法腹腔镜下插入式输尿管膀胱再植术安全、有效。手术时间明显缩短、没有增加吻合口狭窄及输尿管反流等并发症的发生率，有可能降低吻合口狭窄的发生率。

Abstract:

Objective?To discuss the safety and efficacy of inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture.?Methods?There was an retrospective analysis on operation videos and clinical data for 16 participants of inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture with the period from March in 2012 to September in 2015. And these were statistically analyzed including the operation time, intraoperative bleeding volume, postoperative drainage volume, removal time of drainage tube, admission time after operation and the incidence of postoperative complications of vesicoureteric reflux and stenosis.?Results?The operations of 16 participants were completed successfully without converting to open surgery. The operation time was 60 ~ 125 min (Mean time: 85 min); intraoperative bleeding volume was 20 ~ 50 ml (Mean volume: 32 ml); postoperative drainage volume was 60 ~ 400 ml (Mean volume: 106 ml); removal time of drainage tube was 3 ~ 6 d (Mean time: 4.2 d) and admission time after operation was 7 ~ 10 d (Mean time: 8.5 d). There was the follow-up with 6 ~ 18 months (Mean time: 12 months) for participants. No anastomotic stenosis was present. In addition, one participant was suffered from mild vesicoureteric reflux. And there was no aggravation during 18 months.?Conclusions?The inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture was safe and effective. It was found that the operation time was significantly shortened and the incidence of postoperative complications of vesicoureteric reflux and anastomotic stenosis was not increased. By contrast, the six-stitch suture could reduce the incidence of anastomotic stenosis.