Department of Urology, Children's Hospital of Fudan University, Shanghai 201102, China.
J Pediatr Surg. 2012 Dec;47(12):2285-8. doi: 10.1016/j.jpedsurg.2012.09.020.
To evaluate the efficacy of laparoscopic pneumovesical ureter reimplantation for congenital malformation involving the vesicoureteral junction in children.
From January 2005 to October 2010, 45 cases (comprising 61 ureters) were diagnosed as megaureter caused by vesicoureteral junction obstruction. A pneumovesical laparoscopic Cohen procedure was performed in all cases. Twelve of the ureters underwent excisional ureteral tapering. Ureteral diameters were obtained using ultrasonography and were divided into 4 groups according to the degree of dilatation.
The procedure was completed in all but 2 patients, who were converted to open surgery. The mean operation time was 3.5h (range, 2-8h) for unilateral ureter cases, 3.7h (range, 3.5-4.5h) for duplicated ureter cases, and 5.4h (range, 3.5-9h) for bilateral cases. The mean duration of urethral catheter placement and hospital stay was 6.7 days (range, 3-14 days) and 8.3 days (range, 4-15 days), respectively. Thirty-five of the patients (48 ureters) were followed up by ultrasonography for 1-67 months (mean, 19.3 months). Ultrasound scans revealed improvement in the degree of dilatation of 32 ureters. In 1 patient, the ultrasound scan showed deterioration of ureteral dilatation. This patient developed stenosis at the neoureteral opening and underwent reoperation 6 months later. Fourteen patients were followed up by micturating cystourethrogram (MCU).Of these, 3 cases (4 ureters) exhibited reflux (2 unilateral cases of grade 1 reflux and grade 3 reflux, respectively, and 1 bilateral case of bilateral grade 1 reflux).
Pneumovesical ureteral reimplantation for vesicoureteral junction obstruction is feasible and effective. In this series, ultrasound scans showed improvement in most ureteral dilatation cases on follow-up.
评估腹腔镜膀胱内输尿管再植术治疗儿童先天性膀胱输尿管连接部畸形的疗效。
2005 年 1 月至 2010 年 10 月，45 例（61 条输尿管）诊断为膀胱输尿管连接部梗阻引起的巨输尿管。所有病例均行腹腔镜 Cohen 手术。12 例输尿管行输尿管狭窄切除术。通过超声测量输尿管直径，并根据扩张程度分为 4 组。
除 2 例患者改行开放手术外，其余患者均完成手术。单侧输尿管手术时间平均为 3.5 小时（范围 2-8 小时），重复输尿管手术时间平均为 3.7 小时（范围 3.5-4.5 小时），双侧输尿管手术时间平均为 5.4 小时（范围 3.5-9 小时）。导尿管留置时间和住院时间平均分别为 6.7 天（范围 3-14 天）和 8.3 天（范围 4-15 天）。35 例（48 条输尿管）患者接受超声随访 1-67 个月（平均 19.3 个月）。超声检查发现 32 条输尿管扩张程度改善。1 例患者超声检查发现输尿管扩张恶化。该患者新吻合口处狭窄，6 个月后再次手术。14 例患者接受排尿性膀胱尿道造影（MCU）随访。其中 3 例（4 条输尿管）出现反流（单侧 2 例分别为 1 级和 3 级反流，双侧 1 例双侧 1 级反流）。
腹腔镜膀胱内输尿管再植术治疗膀胱输尿管连接部梗阻是可行和有效的。在本系列中，超声检查显示大多数输尿管扩张病例在随访中得到改善。
