Wang Zhixiang, Liu Bing, Gao Xiaofeng, Bao Yi, Wang Yang, Ye Huamao, Sun Yinghao, Wang Linhui
Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Asian J Urol. 2015 Oct;2(4):238-243. doi: 10.1016/j.ajur.2015.09.003. Epub 2015 Sep 21.
Complex ureteral obstruction is refractory to conventional urological intervention. This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.
Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male. Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position. The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter, and a guide wire was advanced into the pelvis using ureteroscopy. A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.
The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL. The patient underwent an uneventful postoperative course, and postoperative follow-up radiography confirmed good positioning of the double-J stent. The double-J stent was removed 3 months after operation. The patient remained asymptomatic within a 13-month follow-up period.
Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.
复杂性输尿管梗阻对传统泌尿外科干预措施具有难治性。本报告描述了一例采用腹腔镜输尿管松解术联合输尿管镜检查和经皮肾镜检查治疗复杂性输尿管梗阻的病例。
一名23岁男性患者右侧多发性输尿管结石并伴有输尿管梗阻，首次尝试输尿管镜碎石术联合经皮肾镜检查失败。患者置于改良仰卧瓦尔迪维亚体位（Galdakao-modified supine Valdivia position），同时采用腹腔镜输尿管松解术联合输尿管镜检查和经皮肾镜检查来分离输尿管周围粘连。切开输尿管以便将输尿管导管插入扭曲的输尿管，并使用输尿管镜将导丝推进至盆腔。通过顺行经皮肾镜检查将双J支架置入右侧输尿管。
腹腔镜内镜手术持续330分钟，估计出血量为100毫升。患者术后恢复顺利，术后随访影像学检查证实双J支架位置良好。术后3个月取出双J支架。在13个月的随访期内患者一直无症状。
腹腔镜输尿管松解术联合输尿管镜检查和经皮肾镜检查是治疗复杂性输尿管梗阻的一种有效且安全的治疗选择。
