Dechet C B, Young M M, Segura J W
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Endourol. 1999 Sep;13(7):487-93. doi: 10.1089/end.1999.13.487.
To evaluate the feasibility of laparoscopic transureteroureterostomy (TUU) in a porcine model.
Nine female pigs had bilateral ureteral stents placed 3 weeks prior to surgery. At surgery, a left-to-right laparoscopic TUU was performed. Ureteral stents were placed across the anastomosis in seven cases. Six weeks after surgery, the stents were removed. After an additional 3 weeks, an excretory urogram, retrograde ureteropyelogram, and ureteroscopic examination of the anastomosis were performed. Serum creatinine assay and urine cultures were performed at regular intervals. Antibiotic prophylaxis was used for 1 week after each procedure.
Of the nine animals, eight underwent successful laparoscopic TUU. Excretory urograms revealed prompt function and washout in all these cases. One animal developed an anastomotic stricture; in this animal, the ureters had remained nondilated after initial stent placement. Serum creatinine values remained within the normal range for all animals undergoing successful surgery. Additional complications included one urinary tract infection and one postoperative ileus, which were treated without difficulty. The operative time ranged from 2.5 to 6 hours, with shorter procedures later in the series.
Laparoscopic TUU is practical in the porcine model. It may prove to be an alternative to an open TUU in patients with lower ureteral lesions when ureteroneocystostomy is not feasible.
评估在猪模型中进行腹腔镜下输尿管-输尿管吻合术（TUU）的可行性。
9只雌性猪在手术前3周双侧置入输尿管支架。手术时，进行了从左到右的腹腔镜TUU。7例在吻合口处放置了输尿管支架。术后6周取出支架。再过3周后，进行排泄性尿路造影、逆行输尿管肾盂造影以及吻合口的输尿管镜检查。定期进行血清肌酐检测和尿培养。每次手术后使用抗生素预防1周。
9只动物中，8只成功进行了腹腔镜TUU。排泄性尿路造影显示所有这些病例功能恢复迅速且造影剂排空良好。1只动物出现吻合口狭窄；在这只动物中，最初置入支架后输尿管未扩张。所有成功手术的动物血清肌酐值均保持在正常范围内。其他并发症包括1例尿路感染和1例术后肠梗阻，均顺利治愈。手术时间为2.5至6小时，系列手术后期手术时间较短。
腹腔镜TUU在猪模型中是可行的。对于输尿管下段病变且输尿管膀胱再植术不可行的患者，它可能被证明是开放性TUU的一种替代方法。
