气膀胱腹腔镜手术治疗小儿输尿管末端狭窄56例
|
摘要
目的探讨气膀胱腹腔镜Cohen再植术治疗小儿输尿管末端狭窄的疗效。方法我院2013年4月～2017年4月对56例(62侧)膀胱输尿管连接处梗阻患儿行下腹部三通道气膀胱腹腔镜Cohen再植术,经尿道置入膀胱镜,建立CO_2气膀胱,在膀胱镜直视下带针缝线引导建立"人工腹壁膀胱粘连区",分别置入目镜trocar(5 mm)及2个器械trocar(3 mm),腹腔镜下完成输尿管的游离与再植。术后6个月B超检查评估肾积水及输尿管扩张变化情况,术后12个月IVP检查评估输尿管膀胱连接处通畅情况,并测量肾盂扩张程度和输尿下段管径。结果 56例气膀胱腹腔镜Cohen再植术均获得成功,无中转开放及再手术。手术时间(136. 2±19. 1) min,留置尿管时间(6. 5±1. 6) d,术后住院时间(7. 8±1. 2) d。随访56例,术后6个月B超提示肾盂分离和输尿管扩张较术前[(0. 7±0. 2) cm vs.(2. 1±0. 4) cm,t=24. 980,P=0. 000]、[(0. 5±0. 2) cm vs.(1. 1±0. 2) cm,t=15. 775,P=0. 000]明显减轻。术后12个月IVP复查,56例均显示造影剂通过输尿管膀胱连接处顺畅,其中38例显影清晰,肾盂扩张和输尿下段管径较术前[(0. 6±0. 2) cm vs.(1. 6±0. 4) cm,t=14. 894,P=0. 000]、[(0. 4±0. 1) cm vs.(1. 5±0. 3) cm,t=19. 956,P=0. 000]明显减小。Likert scale量表调查家长对手术外观的满意率98. 2%(55/56)。结论气膀胱腹腔镜Cohen再植术治疗小儿输尿管末端狭窄可行,微创美观且安全有效。
Objective To evaluate the efficacy of gas-bladder laparoscopic Cohen re-plantation in the treatment of terminal ureteral stricture in children. Methods From April 2013 to April 2017,56 children( 62 sides) with obstruction of bladder and ureter junction received lower abdominal three-channel gas-bladder laparoscopic Cohen re-plantation. The artificial abdominal wall bladder adhesion zone was established under the direct vision of cystoscope,and the trocar was inserted under the direct vision of cystoscope. Then the demobilization and re-plantation of ureter was performed under laparoscope by the same doctor. The changes of hydronephrosis and ureteral dilatation were evaluated by B-ultrasound at 6 months after operation,and the patency of uretero-bladder junction was evaluated by IVP at 12 months after operation,as well as the degree of dilatation of renal pelvis and the diameter of lower segment of urinary tract. Results All the 56 cases of gas-bladder Cohen re-plantation were successful. No conversion to open surgery was required. The operation time was( 136. 2 ± 19. 1) min,the indwelling catheter time was( 6. 5 ± 1. 6) d,and the postoperative hospital stay was( 7. 8 ± 1. 2) d. Follow-ups for the 56 cases showed that under B-ultrasonography pelvis separation and ureteral dilatation were significantly relieved at 6 months after operation than those before operation [( 0. 7 ± 0. 2) cm vs.( 2. 1 ± 0. 4)cm,t = 24. 980,P = 0. 000;( 0. 5 ± 0. 2) cm vs.( 1. 1 ± 0. 2) cm,t = 15. 775,P = 0. 000]. At 12 months after operation,IVP examinations showed that the contrast agent was smooth through the uretero-bladder junction in all the 56 cases. In 38 cases having clear imaging,the dilation of renal pelvis and the diameter of the lower segment of urinary tract significantly decreased as compared with those before operation [( 0. 6 ± 0. 2) cm vs.( 1. 6 ± 0. 4) cm,t = 14. 894,P = 0. 000;( 0. 4 ± 0. 1) cm vs.( 1. 5 ± 0. 3) cm,t = 19. 956,P = 0. 000]. The Likert scale surveyed parents' satisfaction with the appearance of surgery as high as 98. 2%( 55/56).Conclusion Gas-bladder laparoscopic Cohen re-plantation is feasible,minimally invasive and effective in the treatment of ureteral terminal stenosis in children.
Objective To evaluate the efficacy of gas-bladder laparoscopic Cohen re-plantation in the treatment of terminal ureteral stricture in children. Methods From April 2013 to April 2017,56 children( 62 sides) with obstruction of bladder and ureter junction received lower abdominal three-channel gas-bladder laparoscopic Cohen re-plantation. The artificial abdominal wall bladder adhesion zone was established under the direct vision of cystoscope,and the trocar was inserted under the direct vision of cystoscope. Then the demobilization and re-plantation of ureter was performed under laparoscope by the same doctor. The changes of hydronephrosis and ureteral dilatation were evaluated by B-ultrasound at 6 months after operation,and the patency of uretero-bladder junction was evaluated by IVP at 12 months after operation,as well as the degree of dilatation of renal pelvis and the diameter of lower segment of urinary tract. Results All the 56 cases of gas-bladder Cohen re-plantation were successful. No conversion to open surgery was required. The operation time was( 136. 2 ± 19. 1) min,the indwelling catheter time was( 6. 5 ± 1. 6) d,and the postoperative hospital stay was( 7. 8 ± 1. 2) d. Follow-ups for the 56 cases showed that under B-ultrasonography pelvis separation and ureteral dilatation were significantly relieved at 6 months after operation than those before operation [( 0. 7 ± 0. 2) cm vs.( 2. 1 ± 0. 4)cm,t = 24. 980,P = 0. 000;( 0. 5 ± 0. 2) cm vs.( 1. 1 ± 0. 2) cm,t = 15. 775,P = 0. 000]. At 12 months after operation,IVP examinations showed that the contrast agent was smooth through the uretero-bladder junction in all the 56 cases. In 38 cases having clear imaging,the dilation of renal pelvis and the diameter of the lower segment of urinary tract significantly decreased as compared with those before operation [( 0. 6 ± 0. 2) cm vs.( 1. 6 ± 0. 4) cm,t = 14. 894,P = 0. 000;( 0. 4 ± 0. 1) cm vs.( 1. 5 ± 0. 3) cm,t = 19. 956,P = 0. 000]. The Likert scale surveyed parents' satisfaction with the appearance of surgery as high as 98. 2%( 55/56).Conclusion Gas-bladder laparoscopic Cohen re-plantation is feasible,minimally invasive and effective in the treatment of ureteral terminal stenosis in children.
引文
1 Bulent O,Hamza GM,Fatih SM.Preputial graft ureteroplasty for the treatment of complex ureteral stricture:a new surgical technique and review of literature.J Endourol Case Rep,2018,4(1):136-139.
2 Jeremy AK,Dunia TK,Daniel JC,et al.Ileocalicostomy ureteral substitution for complex ureteropelvic junction stricture:technique and initial experience.Urology,2018,122(11):174-178.
3 Lau CT,Lan LC,Wong KK,et al.Pneumovesical ureteric reimplantation in pediatric patients:an intermediate term result.JLaparoendosc Adv Surg Tech A,2017,27(2):203-205.
4 Kurtz MP,Leow JJ,Varda BK,et al.Robotic versus open pediatric ureteral reimplantation:Costs and complications from a nationwide sample.J Pediatr Urol,2016,12(6):408.e1-e6.
5 Freifeld Y,Diazde Leon A,Xi Y,et al.Diagnostic performance of prospectively assigned Likert Scale Scores to determine extraprostatic extension and seminal vesicle invasion with multiparametric MRI of the prostate.AJR Am J Roentgenol,2018,29(7):1-6.
6 Michael PK,Caleb PN.Urology mythbusters:The 5∶1 ratio in ureteral reimplantation.J Pediatr Urol,2017,13(2):187-188.
7 Esteban E,Michele T,Marie A,et al.Modern flexible ureteroscopy in Cohen cross-trigonal ureteral reimplantations.J Pediatr Urol,2017,13(3):329-331.
8 Ignacio CV,Gema DJ,Jorge TA,et al.Laparoscopic Boari Flap ureteral reimplantation.Arch Esp Urol,2017,70(4):436-444.
9 Bastab G,Pritesh J,Dilip KP,et al.Managing mid and lower ureteral benign strictures:the laparoscopic way.J Laparoendosc Adv Surg Tech A,2018,28(1):25-32.
10 Gill IS,Ponsky LE,Desai M,et a1.Laparoscopic cross-trigonal Cohen ureteroneo-cystostomy:novel technique.J Urol,2001,166(11):1811-1814.
11 Yeung CK,Borzi P.Pneumovesieopic Cohen ureleric reimplantation with carbon dioxide bladder insufflation for gross VUR.BJU Int,2002,86(7):85-86.
12郝毅,李龙,刘刚,等.气膀胱腹腔镜在治疗膀胱输尿管连接部先天畸形中的应用.中国微创外科杂志,2008,8(6):529-530.
13孙玉芳,毕允力,阮双岁,等.气膀胱腹腔镜在膀胱输尿管连接处狭窄性畸形中的临床应用.中华小儿外科杂志,2012,33(7):504-507.
14任红霞,张旭辉,王计文,等.气膀胱腹腔镜Cohen输尿管移植术治疗先天性膀胱输尿管连接部梗阻.临床小儿外科杂志,2010,9(3):182-183.
15 Kutikov A,Guzzo TJ,Canter DJ,et al.Initial experience with laparoscopic transvesical ureteral reimplantation at the Children’s Hospital of Philadelphia.J Urol,2006,176(43):2222-2225.
16 Jayanthi V,Patel A.Vesicoscopic ureteral reimplantation:a minimally invasive technique for the definitive repair of vesicoureteral reflux.Adv Urol,2008,97(3):616-618.
17孙晶,张森,郑民华.胃肠微创外科临床研究2017年盘点及未来展望.中华胃肠外科杂志,2018,21(1):15-18.
18 Baltayiannis N,Michail C,Lazaridis G,et al.Minimally invasive procedures.Ann Transl Med,2018,17(5):55-57.
19 Kim KH,Lee YS,Im YJ,et al.A modified technique for ureteral reimplantation:intravesical detrusorrhaphy.J Pediatr Surg,2018,48(8):1813-1818.
20 Yamashita M,Toyama E,Sasoh M,et al.Bladder pressure monitoring and CO2 gas-related adverse events during per-oral endoscopic myotomy.J Clin Monit Comput,2018,32(6):1111-1116.
21 Oliveira MAP,Raymundo TS,Pereira TRD,et al.CO2cystoscopy for evaluation of ureteral patency.J Minim Invasive Gynecol,2018,27(9):76-79.
2 Jeremy AK,Dunia TK,Daniel JC,et al.Ileocalicostomy ureteral substitution for complex ureteropelvic junction stricture:technique and initial experience.Urology,2018,122(11):174-178.
3 Lau CT,Lan LC,Wong KK,et al.Pneumovesical ureteric reimplantation in pediatric patients:an intermediate term result.JLaparoendosc Adv Surg Tech A,2017,27(2):203-205.
4 Kurtz MP,Leow JJ,Varda BK,et al.Robotic versus open pediatric ureteral reimplantation:Costs and complications from a nationwide sample.J Pediatr Urol,2016,12(6):408.e1-e6.
5 Freifeld Y,Diazde Leon A,Xi Y,et al.Diagnostic performance of prospectively assigned Likert Scale Scores to determine extraprostatic extension and seminal vesicle invasion with multiparametric MRI of the prostate.AJR Am J Roentgenol,2018,29(7):1-6.
6 Michael PK,Caleb PN.Urology mythbusters:The 5∶1 ratio in ureteral reimplantation.J Pediatr Urol,2017,13(2):187-188.
7 Esteban E,Michele T,Marie A,et al.Modern flexible ureteroscopy in Cohen cross-trigonal ureteral reimplantations.J Pediatr Urol,2017,13(3):329-331.
8 Ignacio CV,Gema DJ,Jorge TA,et al.Laparoscopic Boari Flap ureteral reimplantation.Arch Esp Urol,2017,70(4):436-444.
9 Bastab G,Pritesh J,Dilip KP,et al.Managing mid and lower ureteral benign strictures:the laparoscopic way.J Laparoendosc Adv Surg Tech A,2018,28(1):25-32.
10 Gill IS,Ponsky LE,Desai M,et a1.Laparoscopic cross-trigonal Cohen ureteroneo-cystostomy:novel technique.J Urol,2001,166(11):1811-1814.
11 Yeung CK,Borzi P.Pneumovesieopic Cohen ureleric reimplantation with carbon dioxide bladder insufflation for gross VUR.BJU Int,2002,86(7):85-86.
12郝毅,李龙,刘刚,等.气膀胱腹腔镜在治疗膀胱输尿管连接部先天畸形中的应用.中国微创外科杂志,2008,8(6):529-530.
13孙玉芳,毕允力,阮双岁,等.气膀胱腹腔镜在膀胱输尿管连接处狭窄性畸形中的临床应用.中华小儿外科杂志,2012,33(7):504-507.
14任红霞,张旭辉,王计文,等.气膀胱腹腔镜Cohen输尿管移植术治疗先天性膀胱输尿管连接部梗阻.临床小儿外科杂志,2010,9(3):182-183.
15 Kutikov A,Guzzo TJ,Canter DJ,et al.Initial experience with laparoscopic transvesical ureteral reimplantation at the Children’s Hospital of Philadelphia.J Urol,2006,176(43):2222-2225.
16 Jayanthi V,Patel A.Vesicoscopic ureteral reimplantation:a minimally invasive technique for the definitive repair of vesicoureteral reflux.Adv Urol,2008,97(3):616-618.
17孙晶,张森,郑民华.胃肠微创外科临床研究2017年盘点及未来展望.中华胃肠外科杂志,2018,21(1):15-18.
18 Baltayiannis N,Michail C,Lazaridis G,et al.Minimally invasive procedures.Ann Transl Med,2018,17(5):55-57.
19 Kim KH,Lee YS,Im YJ,et al.A modified technique for ureteral reimplantation:intravesical detrusorrhaphy.J Pediatr Surg,2018,48(8):1813-1818.
20 Yamashita M,Toyama E,Sasoh M,et al.Bladder pressure monitoring and CO2 gas-related adverse events during per-oral endoscopic myotomy.J Clin Monit Comput,2018,32(6):1111-1116.
21 Oliveira MAP,Raymundo TS,Pereira TRD,et al.CO2cystoscopy for evaluation of ureteral patency.J Minim Invasive Gynecol,2018,27(9):76-79.