Kaynan A M, Winfield H N
Stanford University Medical Center, Department of Urology, S-287, Mail Code 5118, 300 Pasteur Drive, Stanford, CA 94305-5118, USA.
Curr Urol Rep. 2001 Apr;2(2):154-64. doi: 10.1007/s11934-001-0013-0.
Although endoscopic methods have become the preferred means of management for many diseases facing the genitourinary surgeon, a laparoscopic approach might be considered comparable or advantageous in select circumstances. In the literature, laparoscopists reporting their work have favored the transperitoneal approach; however, there are clear advantages and disadvantages to both transperitoneal and retroperitoneal laparoscopy. Intracorporeal suturing remains the most time-consuming aspect of reconstructive surgery, and research emphasis has been on suturing devices and novel anastomotic techniques. Laparoscopic pyeloplasty is efficacious and should be considered, particularly in the case of a capacious renal pelvis, crossing vessel, or failed previous endopyelotomy. Laparoscopic pyelolithotomy is uniquely suitable for patients with aberrant anatomy, such as a horseshoe kidney, and may be performed concurrently with pyeloplasty for ureteropelvic junction obstruction. The use of laparoscopic extravesical ureteral reimplantation awaits further development in both open and subtrigonal injection techniques. Its use in colposuspension is undetermined and requires further study as suturing technology improves. During laparoscopic exploration, it is possible to address intraoperative injuries to the ureter and bladder laparoscopically. In summary, laparoscopic surgery of the urinary tract is a "work in progress," but it offers promise for some of the most challenging of circumstances. As the technology advances and the clinical experience widens, the indications and contraindications for these techniques will be better established.
尽管内镜方法已成为泌尿外科医生面对许多疾病时首选的治疗手段，但在某些特定情况下，腹腔镜手术方法可能被认为具有可比性或优势。在文献中，报道其工作的腹腔镜手术医生更倾向于经腹腔途径；然而，经腹腔和后腹腔镜手术都有明显的优缺点。体内缝合仍然是重建手术中最耗时的环节，研究重点一直放在缝合设备和新型吻合技术上。腹腔镜肾盂成形术是有效的，应予以考虑，特别是在肾盂宽大、存在交叉血管或既往肾盂内切开术失败的情况下。腹腔镜肾盂切开取石术特别适合解剖结构异常的患者，如马蹄肾，并且可以与肾盂成形术同时进行以治疗输尿管肾盂连接处梗阻。腹腔镜膀胱外输尿管再植术在开放和三角区下注射技术方面都有待进一步发展。其在膀胱颈悬吊术中的应用尚不确定，随着缝合技术的改进，需要进一步研究。在腹腔镜探查过程中，可以通过腹腔镜处理术中输尿管和膀胱的损伤。总之，尿路腹腔镜手术仍在“不断发展中”，但它为一些最具挑战性的情况带来了希望。随着技术的进步和临床经验的积累，这些技术的适应证和禁忌证将得到更好的确立。
