腹腔镜联合电切镜膀胱憩室切除术的应用效果（附9例报告）

Application effect of combination treatment of laparoscope and resectoscope for bladder diverticula (report of 9 cases)

摘要:

目的 探讨经尿道电切镜下膀胱憩室内置入输尿管导管，以指引腹腔镜膀胱憩室切除术的手术技巧及其临床应用价值。方法 选取2018年12月－2024年5月该院收治的经腹腔膀胱外入路行腹腔镜联合电切镜下膀胱憩室切除术的患者9例。憩室均为单发，最大直径5.0～8.5 cm，中位最大直径为6.40（5.70，7.40）cm。其中，3例患者合并前列腺增生，同期行经尿道等离子前列腺切除术；1例患者同时合并前列腺增生和膀胱结石，同期行经尿道等离子前列腺切除术和膀胱取石术；2例因憩室直接累及输尿管口，行输尿管再植术；1例因同侧输尿管开口毗邻憩室入口，行输尿管镜双J管置入术。结果 9例患者手术均成功。手术时间85～345 min，中位手术时间为160.00（120.00，317.50）min；术中出血量为10～300 mL，中位出血量为20.00（10.00，150.00）mL；无邻近脏器损伤。术后引流管拔除时间为1～3 d，术后留置尿管7～10 d，均未出现尿外渗。随访3～12个月，无复发和肾积水发生。结论 借助电切镜向膀胱憩室内放置输尿管导管指引腹腔镜下膀胱憩室切除术，具有创伤小、出血少和恢复快等优势，是治疗膀胱憩室的有效措施。

Abstract:

Objective To evaluate the surgical technique and clinical value of laparoscopic bladder diverticulectomy guided by inserting ureteral catheters into the diverticulum under plasmakinetic resectoscope.Methods From December 2018 to May 2024, 9 patients underwent laparoscopic bladder diverticulectomy in combination with resectoscope. Each patient had a solitary bladder diverticulum with a median maximum diameter of 6.40 (5.70, 7.40) cm (range: 5.0 ~ 8.5 cm). Among the 9 patients, 3 patients had concurrent benign prostatic hyperplasia (BPH) and simultaneously underwent transurethral plasmakinetic resection of the prostate; 1 patient had concurrent both BPH and bladder calculi, requiring simultaneously underwent plasmakinetic resection of the prostate and bladder calculi removal; 2 patients required ureteral reimplantation as the diverticulum was directly involving the ureteral orifice; 1 case underwent ureteroscopic double-J stent implantation because the opening of the ipsilateral ureter was adjacent to the entrance of the diverticulum.Results Bladder diverticulectomy was successfully performed in the all patients. Median operative time was 160.00 (120.00, 317.50) min (range: 85 ~ 345 min). Median estimated blood loss was 20.00 (10.00, 150.00) mL (range: 10 ~ 300 mL). No iatrogenic injuries to adjacent organs were observed. Pelvic drains were removed 1 ~ 3 d postoperatively, with no urine leakage. Urinary catheters were maintained for 7 ~ 10 d after operation. Follow-up at 3 ~ 12 months showed no recurrence or hydronephrosis in any of the patients.Conclusion Laparoscopic resection of bladder diverticula guided by ureteral catheter placed into bladder diverticula by means of resectoscope has the advantages of less trauma, less bleeding and faster recovery, and is an effective measure for the treatment of bladder diverticula.