Xu Yanbo,Chen Haichen,Ma Lili,et al.Application of Politano-Leadbetter in laparoscopic pneumovesicum approach for ureteral reimplantation for congenital malformation of vesicoureteral junction in children: a report of 10 children[J].Journal of Clinical Pediatric Surgery,2020,19(08):741-745,758.[doi:10.3969/j.issn.1671-6353.2020.08.015]
气膀胱下Politano-Leadbetter输尿管移植术的经验分析
- Title:
- Application of Politano-Leadbetter in laparoscopic pneumovesicum approach for ureteral reimplantation for congenital malformation of vesicoureteral junction in children: a report of 10 children
- Keywords:
- Ureter/TR; Vesico-Ureteral Reflux; Ureteral Diseases
- 分类号:
- R617;R726.1;R693+.12
- 摘要:
- 目的 总结气膀胱腹腔镜下Politano-Leadbetter输尿管移植术的经验。方法 回顾性分析厦门市妇幼保健院小儿外科2018年1月至2018年7月收治的10例输尿管膀胱连接部异常患儿临床资料，患儿均采用气膀胱腹腔镜下Politano-Leadbetter术治疗。其中男童6例，女童4例；年龄1.76~24个月，平均6.9个月。膀胱输尿管连接部狭窄4例，右侧2例，左侧2例；膀胱输尿管反流6例，单侧2例，双侧4例。手术方法：常规建立气膀胱，膀胱镜下置入腹腔镜及操作器械，膀胱内游离输尿管后，应用尿道口-输尿管开口-新输尿管裂孔三点一线原理，准确寻找膀胱外输尿管。自新的裂孔将输尿管重新迁入膀胱，再向原输尿管口建立黏膜下隧道。结果 10例均经气膀胱下完成手术，无一例中转开放手术。单侧手术时间100~185 min，平均131 min；双侧手术时间115~205 min，平均174 min。术中几乎无明显出血。术后8 d拔除尿管后无一例出现排尿困难、切口感染和切口裂开，住院时间7~15 d。10例均获随访，随访时间6~12个月，均无尿漏、膀胱输尿管反流、输尿管膀胱连接部梗阻等并发症发生。结论 气膀胱腹腔镜下行Politano-Leadbetter术成功率高，能保留原始输尿管的开口位置与解剖走向，是小儿输尿管移植术可行的微创手术方式。
- Abstract:
- Objective To review our institutional experience of pneumocystoscopic Cohen ureteric reimplantation. Methods Retrospective analysis was performed for clinical data of 10 children with congenital malformation of vesicoureteral junction undergoing pneumoeystoscopic Politano-Leadbetter reimplantation between January 2018 and July 2018. There were 6 boys and 4 girls with a mean age of 6.9(1.76-24) months. There were congenital vesicoureteral junction obstruction (n=4)(2 left, 2 right) and vesicoureteral reflux (n=6)(2 unilateral, 4 bilateral). Confirmation was made by voiding cystourethrography. A trocar was inserted into bladder after carbon monoxide was insufflated into bladder through cystoscope. Another 2 trocars were inserted laterally in the same way. Politano-Leadbetter procedure was performed through the lateral trocars. Three-point and one-line principle of urethral opening-ureter opening-new ureteric rupture were employed for accurately locating extraurethral ureter. Ureter was relocated to bladder from a new hole, and a submucosal tunnel is established to the original ureteral orifice. Results All patients underwent pneumoeystoscopic Politano-Leadbetter reimplantation successfully. The mean operative duration was 131(100-185) min for unilateral cases and 174(115-205) min for bilateral cases. There was no dysuria, incisional infection or incisional dehiscence after a removal of urinary catheter. During a follow-up period of 6-12 mouths, there was no occurrence of such complications as fistula, vesicoureteral reflux or vesicoureteral junction obstruction. Conclusion Pneumoeystoscopic Politano-Leadbetter reimplantation simplifies operation course. Preserving a longitudinal ureter similar to physiological state, it is an excellent mini-invasive surgery for pediatric ureteral transplantation.
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备注/Memo
收稿日期:2019-11-27。
作者简介:徐延波,Email:52212137@qq.com