Khonsari Sepehr, Lee David I, Basillote Jay B, McDougall Elspeth M, Clayman Ralph V
Department of Urology, University of California, Irvine College of Medicine, Irvine, California, USA.
J Laparoendosc Adv Surg Tech A. 2004 Feb;14(1):47-50. doi: 10.1089/109264204322862360.
Massive bladder diverticula present a technical challenge to the laparoscopic surgeon. We describe a laparoscopic approach to transperitoneal diverticulectomy, using a specific catheter arrangement to allow excellent control of the various portions of the procedure.
A 49-year-old male with longstanding frequency was diagnosed with a 1000 cc bladder diverticulum and bladder neck outlet obstruction. Laparoscopic transperitoneal diverticulectomy was performed using a triple catheter arrangement: endoscopic placement of a Councill catheter in the diverticulum, fluoroscopic positioning of an occlusion balloon catheter in the renal pelvis, and placement of a Cope loop suprapubic tube. Additionally, a transurethral incision of the prostate was performed.
The procedure was completed laparoscopically using a four port transperitoneal approach. During the procedure, the diverticulum could be filled and emptied as needed; the catheter across the diverticular neck facilitated subsequent closure of the bladder wall defect. The diverticulum was completely excised. The remaining defect in the bladder was then closed in 2 layers. The patient was discharged on postoperative day 3.
Careful planning and arrangement of catheters in the bladder, ureter, and diverticulum facilitates laparoscopic transperitoneal diverticulectomy of even a very large volume diverticulum.
巨大膀胱憩室给腹腔镜外科医生带来技术挑战。我们描述一种腹腔镜经腹憩室切除术的方法，使用特定的导管布置以实现对手术各部分的良好控制。
一名49岁男性，长期尿频，被诊断为有一个1000立方厘米的膀胱憩室和膀胱颈出口梗阻。采用三导管布置进行腹腔镜经腹憩室切除术：在憩室内内镜放置一根康塞尔导管，在肾盂内透视定位一根阻塞球囊导管，以及耻骨上放置一根科普袢管。此外，还进行了经尿道前列腺切开术。
手术采用四孔经腹入路腹腔镜完成。术中，憩室可根据需要充盈和排空；穿过憩室颈部的导管便于随后关闭膀胱壁缺损。憩室被完全切除。然后将膀胱剩余缺损分两层关闭。患者术后第3天出院。
在膀胱、输尿管和憩室内仔细规划和布置导管有助于对即使是非常大体积的憩室进行腹腔镜经腹憩室切除术。
