完全腹腔镜下膀胱翻瓣成形治疗输尿管全段撕脱伤的效果观察

魏海彬; 白宇晨; 毛祖杰; 张琦; 李恩惠; 祁小龙; 刘锋; 张大宏

doi:10.16766/j.cnki.issn.1674-4152.002450

完全腹腔镜下膀胱翻瓣成形治疗输尿管全段撕脱伤的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.002450

魏海彬^{1, 2},
白宇晨¹,
毛祖杰¹,
张琦¹,
李恩惠¹,
祁小龙¹,
刘锋¹,
张大宏^1, ,

1.
浙江省人民医院杭州医学院附属人民医院泌尿外科, 浙江杭州 310014
2.
浙江中医药大学第二临床医学院, 浙江杭州 310053

基金项目:

浙江省医药卫生重大科技计划项目 WKJ2012-2-019

详细信息

通讯作者:
张大宏，E-mail：zhangdahong88@yeah.net

中图分类号: R693
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- 文章访问数: 328
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- 被引次数: 0
出版历程
- 收稿日期: 2021-05-21
- 网络出版日期: 2022-09-05

Observation on the effect of complete laparoscopic bladder flap plasty for full-length ureteral avulsion

1.
Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China

摘要

摘要: 目的探讨完全腹腔镜下膀胱翻瓣成形及带蒂大网膜包裹修复手术治疗输尿管全段缺失(从肾盂、输尿管连接处至输尿管末端)的可行性及安全性。方法回顾性分析于2014年11月—2019年8月浙江省人民医院诊治的5例全段输尿管撕脱伤患者的临床资料，其中右侧3例，左侧2例。5例患者均于外院行内镜手术术中出现全程输尿管撕脱，其中3例行一期急诊手术修复，1例患者反复更换DJ管、1年后行二期手术修复，1例于初次手术术中行开放手术进行输尿管原位回纳修复、5 d后出现尿漏、腹膜炎再行二期手术修复；所有患者均采用完全腹腔镜下膀胱翻瓣成形及带蒂大网膜包裹手术进行修复，收集并记录围手术期及随访期的临床资料。结果 5例患者的修复重建手术均顺利完成。住院期间无尿外渗、腹膜后感染、肾积水等发生。3例行急诊手术的患者，在更换一次DJ管后，于术后6个月返院拔除DJ管。余下2例患者，1例5 d后行二期手术的患者于术后3个月更换DJ管，目前仍是置管状态，另1例患者因腰酸而反复更换DJ管，于术后1年时行腹腔镜下患侧肾切除术。除肾切除患者外，无集合系统分离加重及吻合处狭窄等发生。术后排尿通畅，尿频及输尿管反流不明显，膀胱造影呈梨形，偏向患侧，容量略小。结论完全腹腔镜下膀胱翻瓣成形及带蒂大网膜包裹修复手术是治疗输尿管全段缺损一种安全有效的微创治疗方法。
- 腹腔镜 /
- 输尿管 /
- 撕脱伤 /
- 重建
Abstract: Objective To explore the feasibility and safety of laparoscopic bladder flap reconstruction and pedicled omentum coverage for full-length ureteral avulsion (from the junction of the renal pelvis and ureter to the end of the ureter). Methods The clinical data of 5 patients with full-length ureteral avulsion admitted to the Department of Urology, Zhejiang Provincial People's Hospital from November 2014 to August 2019, including 3 cases on the right side and 2 cases on the left side, were retrospectively analysed. All cases of ureteral avulsion occurred during the endoscopic lithotripsy in the other hospital. Three patients underwent one-stage emergency surgical repair. One patient had repeated replacement of the DJ tube and second-stage surgical repair 1 year later. Another patient underwent open surgery during the initial surgery to repair the ureter in situ. Second-stage surgical repair was performed 5 days later due to urine leakage and peritonitis. All patients underwent complete laparoscopic bladder flap formation and pedicled omentum wrapping surgery. Clinical data were collected and recorded during the perioperative and follow-up period. Results All repair and reconstruction operations were successfully completed. No urine extravasation, retroperitoneal infection and hydronephrosis occurred during hospitalisation. For the 3 patients undergoing emergency surgery, the DJ tube was replaced once and removed 6 months postoperatively. In the patient who underwent second-stage operation 5 days later, the DJ tube was changed 3 months postoperatively, and the patient was still in the state of intubation. In another patient, the DJ tube was changed repeatedly due to backache, and the patient underwent laparoscopic nephrectomy on the affected side 1 year after the operation. Except for the patient undergoing nephrectomy, no aggravated separation of the collection system and stenosis of the anastomosis occurred. Postoperative urination was smooth, and frequence and ureteral reflux were not obvious. The cystography was pear-shaped and biased to the affected side, and the volume was slightly smaller. Conclusion Complete laparoscopic bladder flap plasty and pedicled omental wrap repair surgery is a safe and effective minimally invasive treatment method for full-length ureteral defects.
- Laparoscopy /
- Ureter /
- Avulsion /
- Reconstruction

HTML全文

图 1 完全腹腔镜下膀胱翻瓣成形及带蒂大网膜包裹修复手术过程

注：A示DJ管置入瓣管成形；B示大网膜覆盖。

Figure 1. Complete laparoscopic bladder flap plasty and pedicled omentum wrapping repair

下载: 全尺寸图片幻灯片

图 2 术后3个月随访时输尿管镜检查图片

注：A为术后3个月时输尿管探查，管腔内降解的缝线；B为术后3个月时输尿管探查，肾盂及新输尿管吻合处。

Figure 2. Image of ureteroscopy at 3 months follow-up

下载: 全尺寸图片幻灯片

表 1 5例患者基本资料

Table 1. Basic data of 5 patients

序号	年龄(岁)	性别	侧别	撕脱或缺损时间	缺损长度(cm)	手术时间(min)	术中出血(mL)	术前分肾功能检查(患肾，mL/min)	随访时间	随访分肾功能检查(患肾, mL/min)
1	44	男性	右	4 h	21	150	45	未行	5年	26
2	69	女性	右	1年	20	145	120	27	2年	13
3	7	女性	左	2 h	14	89	75	未行	3年	未行
4	68	女性	左	5 h	20	220	70	未行	6个月	未行
5	56	男性	右	7 d	20	125	50	未行	4个月	未行

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