经脐单孔腹腔镜乳头式输尿管膀胱再植术初步体会

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1、经脐单孔腹腔镜乳头式输尿管膀胱再植术初步体会作者：韩金利黄健许可慰林天歆江春黄海尹心宝张彩霞谢文练姚友生【摘要】【目的】探讨采用自制多通道套管和常规器械经脐行腹腔镜下乳头式输尿管膀胱再植术的可行性和疗效。【方法】2009年4月至2009年12月对9例输尿管末端狭窄或异位开口的患者行腹腔镜输尿管膀胱再植术。气管内全麻下经脐部切口置入自制多通道套管(用手套和两个弹性橡胶环制作而成)。从髂血管分叉处找到并游离异常输尿管至膀胱壁段处切断，末端1cm纵行切开外翻缝合形成乳头，输尿管内置双J管，从膀胱后顶部切口插入膀胱约1～1.5cm，4-0

2、可吸收线间断吻合6针，检查无渗漏后放置盆腔引流。【结果】全部手术均在单孔腹腔镜下成功完成，无需术中增加套管或开放手术。平均手术时间为87min，平均估计失血量小于30mL，无术中并发症发生，术后1d可起床活动，引流管、尿管、双J管分别在2d、7d、30d拔除，内镜下可见输尿管乳头，术后2～3月静脉尿路造影(IVU)及膀胱尿道造影未见吻合口狭窄和反流，脐部切口美观。【结论】经脐单孔腹腔镜下输尿管膀胱再植术具有创伤小、美观经济、恢复快的优点。输尿管乳头式膀胱再植法狭窄率低、抗反流效果好，镜下操作简便，值得推广应用。9【关键词】腹腔镜;

3、单孔系统;输尿管膀胱再植术;脐　Abstract：【Objective】Toevaluatethefeasibilityandeffectoflaparoscopicsurgeryofureterovesicalreimplantationthroughtransumbilicalsingle-portaccessusinghomemademultichannelcannulawithconventionallaparoscopicinstruments.【Method】BetweenApril2009andDecember200

4、9，9patientswithureterendstrictureorectopicorificewereperformedsingle-portlaparoscopicsurgeryofureterovesicalreimplantation.Themultichannelportmadeofgloveandtwoelasticrubberringswasinsertedtransumbilicallyundergeneralanesthesia.Theabnormalureterwasmobilizedfromcommonil

5、iacarterybranchestothebladder.The1cmofureterendwasopenedlongitudinallyandformedsplitnipple.DoubleJstentwasinsertedintotheureter.Theureteralsplitnipplewasinsertedintothebladderattheposteriorvertexofthebladderandfixedbyinterruptedsuturewith4-0absorbablesuture.Thedrainag

6、etubewasputintothepelvicaftertheureterovesicalanastomosiswaswatertight.【Result】Allprocedureswerecompletedsuccessfullywithoutapplicationofadditionalportsorconversiontoopensurgery.Themeanoperativetimewas87min.Themeanestimatedbloodlosswasless9than30mL.Noneofcomplications

7、occurredperioperatively.Thepatientswereambulantin1dayafteroperation.Drainagetube，catheteranddoubleJstentwereremovedin2，7，and30dayspostoperatively，respectively.Splitnipplewasobservedunderendoscopyonemonthpostoperatively.Postoperativeintravenousurographyandcystourethrog

8、raphyin2or3monthsshowednostrictureorrefluxofureterovesicalanastomosis.Umbilicalcosmeticresultsachieved.【Conclusion】Transumbi