Janssen T, Bassi S, Cussenot O, Colomer S, Teillac P, Le Duc A
Service d'Urologie Hôpital Saint-Louis, Paris.
Prog Urol. 1994 Feb;4(1):70-5.
Laparoscopic urological surgery is currently in a phase of development. In order to evaluate the possibility of treating vesicoureteric reflux by laparoscopy, we performed an elongation of the submucosal ureteric tract via an extravesical approach (Lich-Gregoir) in 4 pigs. After creating a pneumoperitoneum, 4 trocars were introduced into the abdominal cavity. The peritoneum was incised at the level of the iliac vessels and the ureter was released at its middle portion as far as the ureterovesical junction. After coagulation, the detrusor was then incised proximally in relation to the ureterovesical junction, revealing 3 to 4 cm of vesical mucosa. The ureter was buried in the muscular groove, the edges of which were brought together by means of 6 metal staples. In 3 pigs, the bladder and ureter were immediately removed by laparotomy. On macroscopic examination, the staples correctly approximated the muscle layer without transfixing the bladder mucosa or ureter. The patency of the ureter was assessed with a probe. The submucosal tract was sufficiently large, preventing any ureteric compression. In 1 pig, the ureteric meati were incised endoscopically to create reflux. After laparoscopic elongation of the submucosal tract on one side, only the untreated ureter continued to reflux. Correction of vesicoureteric reflux is technically feasible in the pig. Longer studies are necessary before considering the application of this technique to man.
腹腔镜泌尿外科手术目前正处于发展阶段。为了评估通过腹腔镜治疗膀胱输尿管反流的可能性，我们对4头猪采用经膀胱外途径（利希 - 格雷戈尔术式）进行了输尿管黏膜下通道延长术。建立气腹后，将4个套管针插入腹腔。在髂血管水平切开腹膜，在输尿管中部直至输尿管膀胱连接处游离输尿管。凝固后，在输尿管膀胱连接处近端切开逼尿肌，露出3至4厘米的膀胱黏膜。将输尿管埋入肌槽内，并用6个金属吻合钉将其边缘拉拢。在3头猪中，通过剖腹术立即切除膀胱和输尿管。肉眼检查显示，吻合钉正确地使肌层对合，未穿透膀胱黏膜或输尿管。用探子评估输尿管的通畅性。黏膜下通道足够大，可防止输尿管受压。在1头猪中，通过内镜切开输尿管口以制造反流。在一侧进行腹腔镜黏膜下通道延长术后，只有未处理的输尿管继续出现反流。在猪身上，技术上可行膀胱输尿管反流矫正术。在考虑将该技术应用于人类之前，还需要进行更长时间的研究。
