腹腔镜Lich-Gregoir输尿管再植术治疗小儿 膀胱输尿管反流（附15例报告）

Laparoscopic Lich-Gregoir ureteral reimplantation for vesicoureteral reflux in children (report of 15 cases)

摘要:

目的 评价腹腔镜Lich-Gregoir输尿管再植术治疗小儿膀胱输尿管反流的治疗效果。方法 回顾分析15例原发性膀胱输尿管反流患儿，年龄6个月～9岁，反流III°~IV°，其中双侧4例。穿刺腹腔内建立二氧化碳（CO2），气腹，于脐下置入5 mm目镜鞘管（Trocar）并固定，两侧放置5 mm操作鞘管。切开膀胱浆肌层约3 cm，包埋输尿管形成膀胱逼尿肌隧道，术后留置导尿3～5 d。结果 15例均经腹腔镜完成手术。无中转开放手术。所有病例手术时间45～160 min。术后2例出现血尿，2日后消失。术后随访6～24个月，1例双侧输尿管包埋术后患儿出现右侧输尿管膀胱吻合口梗阻，术后6个月再次行腹腔镜输尿管再植术（乳头吻合）后梗阻缓解。1例仍存在膀胱输尿管反流I°，因无泌尿系感染、定期随访。结论 腹腔镜Lich-Gregoir输尿管移植手术治疗膀胱输尿管反流是一种安全有效的手术，术后恢复快，具有微创优势。

Abstract:

【Objective】 To review the efficacy of laparoscopic Lich-Gregoir ureteral reimplantation for vesicoureteral reflux. 【Methods】 We analyze 15 cases(aged from 6 months to 9 years) vesicoureteral reflux(III to V) were analyzed . In all the patient, 15 cases suffered from vesicoureteral reflux (4 in bilateral sides). A trocar (5 mm) was inserted through umbilicus into abdominal cavity, other 2 trocars (3 mm) were inserted from two sides. The electrical surgery unit was used to cut muscular layer. Detrusor tunnel is approximately 3 cm. And postoperatively ,a Foley catheter was inserted to drainage during three to five days postoperatively. 【Results】 All procedures were completed without open operation. The duration of operations ranged from 45 min to 160 min. All patients were followed up from 6 to 24 months, 1 patient had vesicoureteral obstruction, and 1 patient had vesicoureteral reflux, and no the urinary tract infection was successfully controlled by anti-infectious treatment. 【Conclusion】The laparoscopic Lich-Gregoir ureteral reimplantation is satisfy,effective.