McDougall E M, Urban D A, Kerbl K, Clayman R V, Fadden P, Royal H D, Chandhoke P S, Stone A M
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63141.
J Urol. 1995 Feb;153(2):497-500. doi: 10.1097/00005392-199502000-00070.
To date, laparoscopic urological surgery has largely been limited to diagnostic or ablative procedures. Herein we report our experience with laparoscopic reconstructive surgery to perform an extravesical ureteral reimplantation. Seven anesthetized pigs with iatrogenic ureteral reflux underwent a laparoscopic extravesical ureteral reimplantation. The newly created ureteral tunnel varied from 2 to 4 cm. In 3 pigs, the tunnel was created with tacking staples, while in the other 4 pigs, the tunnel was created with intracorporeal suturing techniques using a 3-zero polyglyconate running suture. The procedure required an average of 132 minutes. There was one anesthetic death. There were no urinary tract infections. At 3 to 8 weeks after reimplantation, the cystograms were repeated on 5 pigs. One of 2 stapled reimplant pigs still had reflux; 1 of 3 sewn reimplant pigs had reflux. At 6 months following the reimplantation, only 1 pig had residual grade I reflux and this was a sutured reimplantation. None of the stapled reimplantations exhibited any residual reflux on the surgical side; however, in 1 animal a submucosal staple was noted at the time of harvest.
迄今为止，腹腔镜泌尿外科手术在很大程度上局限于诊断性或消融性手术。在此，我们报告我们进行腹腔镜重建手术以实施膀胱外输尿管再植术的经验。七只麻醉状态下的患有医源性输尿管反流的猪接受了腹腔镜膀胱外输尿管再植术。新创建的输尿管隧道长度在2至4厘米之间。3只猪的隧道是用吻合钉创建的，而另外4只猪的隧道是使用3-0聚乙醇酸连续缝合线通过体内缝合技术创建的。该手术平均需要132分钟。有1只猪死于麻醉。未发生尿路感染。再植术后3至8周，对5只猪重复进行膀胱造影。2只使用吻合钉再植的猪中有1只仍有反流；3只缝合再植的猪中有1只存在反流。再植术后6个月，只有1只猪有I级残余反流，这是一只采用缝合方法再植的猪。所有使用吻合钉再植的猪在手术侧均未出现任何残余反流；然而，在1只动物取材时发现有一枚黏膜下吻合钉。
