Zhong Wenlong, Yao Lin, Cui Haoran, Yang Kunlin, Wang Gang, Xu Tao, Ye Xiongjun, Li Xuesong, Zhou Liqun
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
Department of Urology, Peking University People's Hospital, No. 133 Fuchengmennei St, Xicheng District, Beijing, 100034, China.
Int Urol Nephrol. 2017 Nov;49(11):1973-1978. doi: 10.1007/s11255-017-1687-7. Epub 2017 Aug 29.
To evaluate the long-term outcomes of laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy for adult obstructive megaureter and compare the results with the open procedure.
From January 2007 to July 2013, 22 patients underwent laparoscopic and 28 patients underwent open ureteral reimplantation for adult obstructive megaureter. For laparoscopic group, the dilated ureter was delivered out of through a 12-mm port and the distal end was tailored and formed into an antireflux nipple extracorporeally. The ureteral nipple was intracorporeally reimplanted into the posterolateral wall of the bladder. Demographics, complications and follow-up data were analyzed and compared retrospectively between the groups.
Baseline characteristics including age, gender, body mass index, affected side, age at diagnosis and follow-up time were statistically similar for the groups. All of the surgeries were performed successfully, and no major complications occurred. Comparing with the open group, the use of our novel laparoscopic procedure resulted in less estimated blood loss (50.0 vs. 71.0 ml; P = 0.001), less narcotic analgesic (3.0 vs. 18.0 mg; P = 0.01) and shorter hospital stay (5.1 vs. 7.9 days; P < 0.001). Long-term outcomes including rates of recurrent ureteral stricture (4.5 vs. 0%; P = 0.25), rates of vesicoureteral reflux (9.1 vs. 3.6%, P = 0.42) and success rates (86.4 vs. 96.9%; P = 0.45) did not significantly differ between the two groups.
Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy is a safe and equally effective as the open surgery for the long-term outcomes of adult obstructive megaureter.
评估腹腔镜输尿管再植术联合体外剪裁及直接乳头输尿管膀胱吻合术治疗成人梗阻性巨输尿管的长期疗效，并将结果与开放手术进行比较。
2007年1月至2013年7月，22例患者接受了腹腔镜输尿管再植术，28例患者接受了开放输尿管再植术治疗成人梗阻性巨输尿管。对于腹腔镜组，将扩张的输尿管通过一个12毫米的端口引出，远端在体外进行剪裁并形成抗反流乳头。输尿管乳头在体内重新植入膀胱后壁。对两组的人口统计学、并发症和随访数据进行回顾性分析和比较。
两组的基线特征，包括年龄、性别、体重指数、患侧、诊断年龄和随访时间，在统计学上相似。所有手术均成功完成，未发生重大并发症。与开放组相比，我们新颖的腹腔镜手术估计失血量更少（50.0比71.0毫升；P = 0.001），使用的麻醉性镇痛药更少（3.0比18.0毫克；P = 0.01），住院时间更短（5.1比7.9天；P < 0.001）。两组的长期疗效，包括输尿管狭窄复发率（4.5%比0%；P = 0.25）、膀胱输尿管反流率（9.1%比3.6%，P = 0.42）和成功率（86.4%比96.9%；P = 0.45）没有显著差异。
腹腔镜输尿管再植术联合体外剪裁及直接乳头输尿管膀胱吻合术治疗成人梗阻性巨输尿管的长期疗效与开放手术一样安全且同样有效。
