Fergany A, Gill I S, Abdel-Samee A, Kaouk J, Meraney A, Sung G
Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology and Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2001 Nov;166(5):1920-3.
The bladder or Boari flap is a useful technique for ureteroneocystostomy when the distal ureter is too short to reach the bladder without undue tension. We report our experience with laparoscopic Boari flap ureteroneocystostomy in the chronic porcine model.
Six female farm pigs underwent unilateral laparoscopic Boari bladder flap ureteroneocystostomy. Refluxing direct ureteral reimplantation was performed in the initial 3 animals. In the next 3 animals a submucosal tunnel was formed to achieve nonrefluxing ureteroneocystostomy into the Boari flap. The animals were sacrificed 6 weeks after surgery. At sacrifice ascending cystography, ipsilateral antegrade pyelography and autopsy examination of the ureteroneocystostomy site was performed.
No intraoperative or postoperative complications were noted. Average operative time was 140 minutes. Postoperatively serum creatinine and hemoglobin were normal in all pigs. All 3 animals with direct ureteroneocystostomy into the Boari flap had free reflux into the kidney and all 3 with a submucosal tunnel reimplant had no reflux on ascending cystography and free drainage on antegrade pyelography. Autopsy confirmed a patent anastomotic site in all 6 cases.
Laparoscopic ureteroneocystostomy using the Boari bladder flap technique is feasible. Our survival porcine model confirms the successful application of the refluxing and nonrefluxing technique of ureteral reimplantation. Clinical application of the technique has the potential to decrease patient morbidity associated with traditional open surgery.
当远端输尿管过短，无法无张力地到达膀胱时，膀胱或博阿利皮瓣是输尿管膀胱吻合术的一种有用技术。我们报告在慢性猪模型中进行腹腔镜博阿利皮瓣输尿管膀胱吻合术的经验。
6只雌性农场猪接受了单侧腹腔镜博阿利膀胱皮瓣输尿管膀胱吻合术。最初的3只动物进行了反流性直接输尿管再植术。在接下来的3只动物中，形成了一个黏膜下隧道，以实现将输尿管无反流地植入博阿利皮瓣。术后6周对动物实施安乐死。安乐死时，进行了上行膀胱造影、同侧顺行肾盂造影以及输尿管膀胱吻合部位的尸检。
未观察到术中或术后并发症。平均手术时间为140分钟。术后所有猪的血清肌酐和血红蛋白均正常。所有3只将输尿管直接植入博阿利皮瓣的动物均有尿液反流至肾脏，而所有3只进行黏膜下隧道再植的动物在膀胱造影时均无反流，顺行肾盂造影显示引流通畅。尸检证实所有6例吻合部位均通畅。
使用博阿利膀胱皮瓣技术进行腹腔镜输尿管膀胱吻合术是可行的。我们的存活猪模型证实了输尿管再植反流和无反流技术的成功应用。该技术的临床应用有可能降低与传统开放手术相关的患者发病率。
