Yeung C K, Sihoe J D, Tam Y H, Lee K H
Division of Paediatric Surgery, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
BJU Int. 2001 Apr;87(6):505-8. doi: 10.1046/j.1464-410x.2001.00132.x.
To report our experience of laparoscopic excision of symptomatic prostatic utricles in children.
Prostatic utricles were excised laparoscopically in four boys (mean age 6.3 years, range 1.5-17). Cysto-urethroscopy and cannulation of the prostatic utricle was initially undertaken with a cystoscope that was left in situ inside the prostatic utricle to facilitate subsequent identification and mobilization during the laparoscopic procedure. Laparoscopy was conducted via a 5-mm port inserted through a supra-umbilical incision. Two more 5 mm working ports were inserted at the right and left mid-abdomen. The prostatic utricle was easily identified with the guidance of cystoscopic transillumination. Dissection was further facilitated by lifting and counter-traction of the prostatic utricle using the indwelling cystoscope. The prostatic utricle was completely mobilized and divided at its confluence with the urethra using an ultrasonic scalpel.
Laparoscopic excision of the prostatic utricle was successful in all four patients. The urethral defect was closed by intracorporeal suturing in three patients while the defect was small enough to be adequately closed by ultrasonic coagulation in one. One patient also had a nonfunctioning dysplastic kidney associated with an ectopic ureter joining into the prostatic utricle, and underwent nephroureterectomy at the same setting. The mean (range) operative duration was 148 (105-225) min. All four patients recovered uneventfully with no complications.
Laparoscopic excision under cystoscopic guidance is effective for symptomatic prostatic utricles, offering a good surgical view and allowing easy dissection in a deep and narrow pelvic cavity.
报告我们对有症状的小儿前列腺囊进行腹腔镜切除的经验。
对4名男孩（平均年龄6.3岁，范围1.5 - 17岁）进行了前列腺囊的腹腔镜切除。最初使用膀胱镜进行膀胱尿道镜检查并插入前列腺囊，将膀胱镜留在前列腺囊内以方便后续腹腔镜手术中的识别和游离。通过脐上切口插入一个5毫米的端口进行腹腔镜检查。在左右中腹部再插入两个5毫米的工作端口。在膀胱镜透照引导下很容易识别前列腺囊。使用留置的膀胱镜提起并反向牵拉前列腺囊，进一步便于解剖。使用超声刀将前列腺囊完全游离并在其与尿道汇合处切断。
4例患者均成功进行了前列腺囊的腹腔镜切除。3例患者通过体内缝合关闭尿道缺损，1例患者的缺损足够小，通过超声凝固即可充分关闭。1例患者还伴有一个无功能的发育异常肾脏及一条异位输尿管汇入前列腺囊，在同一手术中进行了肾输尿管切除术。平均手术时间（范围）为148（105 - 225）分钟。所有4例患者均顺利康复，无并发症。
膀胱镜引导下的腹腔镜切除对有症状的前列腺囊有效，能提供良好的手术视野，便于在深而窄的盆腔内进行解剖。
