Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
Urology. 2013 Nov;82(5):1171-4. doi: 10.1016/j.urology.2013.07.019. Epub 2013 Sep 12.
To describe a novel technique using extracorporeal tailoring and an inverted ureteral nipple to perform laparoscopic transperitoneal ureteral reimplantation for adult obstructed megaureter and our initial experience with 10 patients.
Ten patients (mean age 39.2 years [range, 21-62]) with adult obstructed megaureter underwent transperitoneal laparoscopic ureteral reimplantation by a 3- or 4-port technique. In each case, the affected ureter was freed and delivered out of the peritoneal cavity through the ipsilateral 12-mm port. The lower end of the ureter was tailored by approximately 6 cm, and the tip was folded back onto itself and secured with absorbable sutures to form a nipple. A double-J stent was placed, the entire assembly was carefully replaced into the abdomen, and the ureter was reimplanted into the posterolateral wall of the bladder.
Surgery was successful in all the 10 patients without the need for open conversion. At a mean follow-up of 17 months, all patients were asymptomatic, and hydronephrosis was relieved in 9 cases. Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy is an easy, safe, and effective procedure for adult obstructed megaureter.
描述一种使用体外剪裁和反向输尿管乳头的新技术，用于成人梗阻性巨输尿管的腹腔镜经腹腔输尿管再植术，以及我们在 10 例患者中的初步经验。
10 例（平均年龄 39.2 岁[范围，21-62]）成人梗阻性巨输尿管患者采用 3 或 4 孔技术行经腹腔腹腔镜输尿管再植术。在每种情况下，受影响的输尿管均被松解并通过同侧 12mm 端口送达腹腔外。输尿管的下端被剪裁约 6cm，尖端对折并使用可吸收缝线固定形成乳头。放置双 J 支架，小心地将整个组件重新放入腹部，并将输尿管再植到膀胱的后外侧壁。
10 例患者均成功完成手术，无需开放转换。在平均 17 个月的随访中，所有患者均无症状，9 例肾积水得到缓解。对于成人梗阻性巨输尿管，体外剪裁和直接乳头输尿管膀胱吻合术的腹腔镜输尿管再植术是一种简单、安全、有效的方法。
