双镜联合技术在输尿管下段狭窄及损伤中的应用*

Laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique for distal ureteral strictures and injuries*

摘要:

探讨腹腔镜输尿管镜双镜联合技术治疗输尿管下段狭窄及损伤的可行性及临床疗效。方法 对2016年1月－2017年9月该院应用双镜联合技术治疗的18例输尿管下段狭窄及损伤患者的临床资料进行回顾性分析，总结术中情况及手术经验。结果 18例手术均顺利完成，手术时间（172.7±22.5）min，术中出血（132.8±53.1）ml，术后肠蠕动功能恢复时间（1.6±0.4）d，术后下床活动时间（1.4±0.5）d，术后住院时间（7.1±1.7）d。所有患者平均随访（14.3±4.9）个月，无并发症，无输尿管再次狭窄。结论 双镜联合技术可实现输尿管狭窄段/损伤段精确定位及准确切除，并实现输尿管原位吻合，没有解剖学结构改变，是一种安全可行、对机体创伤小且术后康复快的微创治疗方法，值得推广。

Abstract:

To investigate the safety and efficacy of laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique in treatment of distal ureteral strictures and injuries. Methods The clinical data of 18 cases of ureteral distal ureteral strictures and injuries performed surgery from January 2016 to September 2017 were analyzed retrospectively. Results All the 18 operations were completed successfully. The operation time was (172.7 ± 22.5) min; the estimated blood loss was (132.8 ± 53.1) ml; the mean recovery time of gastrointestinal function after operation was (1.6 ± 0.4) d; the postoperative ambulation activity time was (1.4 ± 0.5) d; the mean hospital stay was (7.1 ± 1.7) d. After a period of (14.3 ± 4.9) months’ follow-up, no patient had ureter re-stenosis. Conclusion Laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique for ureteral strictures and injuries is a safe, feasible, minimally invasive and accurate operation, which can accurate resection of stenosis/injury segment, and achieve in situ ureteral anastomosis without anatomical structural changes.