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目的:探讨后腹腔镜输尿管成形术治疗下腔静脉后输尿管的临床经验及疗效。方法:回顾分析2004年1月至2011年10月13例下腔静脉后输尿管患者的临床资料,其中男10例,女3例;平均(33.2±6.8)岁;8例有症状,体检发现5例;13例患者均行后腹腔镜输尿管成形术。结果:13例手术均获成功,无一例中转开放手术。平均手术时间、输尿管端端吻合时间分别为(110±21.1)min、(30.2±11.4)min,术中出血量平均(24.3±5.6)ml,术后平均负压引流(4.0±1.2)d,平均留置导尿管(5.9±2.8)d,平均住院(5.3±1.4)d,术后1个月拔除双J管。术后平均随访(30.2±11.3)个月,13例患者肾及输尿管上段扩张积水显著减轻,吻合口无狭窄,8例患者术前不适症状消失。结论:后腹腔镜输尿管成形术治疗下腔静脉后输尿管安全、有效,具有患者创伤小、康复快等优点,可作为治疗下腔静脉后输尿管的首选方法。但远期疗效尚需大样本对照研究及长期随访观察。
Objective: To investigate the clinical experience and curative effect of retroperitoneal ureteroplasty in the treatment of ureter after inferior vena cava. Methods: The clinical data of 13 patients with posterior inferior vena cava ureter between January 2004 and October 2011 were retrospectively analyzed. There were 10 males and 3 females, with an average of (33.2 ± 6.8) years. Eight patients had symptoms and the physical examination found 5 Cases; 13 patients underwent laparoscopic ureteroplasty. Results: All the 13 surgeries were successful, and none of them underwent open surgery. Mean operative time and ureteral end-to-end anastomosis time were (110 ± 21.1) min and (30.2 ± 11.4) min respectively. The mean intraoperative blood loss was (24.3 ± 5.6) ml and mean postoperative negative pressure drainage (4.0 ± 1.2) The mean indwelling catheter (5.9 ± 2.8) d, the average hospitalization (5.3 ± 1.4) d, one month after the removal of double J tube. After an average follow-up of 30.2 ± 11.3 months, the dilatation and hydrops of renal and ureter in 13 patients were significantly relieved. There was no stenosis in the anastomosis, and the symptoms of preoperative discomfort disappeared in 8 patients. Conclusions: Retroperitoneal laparoscopic ureteroplasty for the treatment of ureter after IVC is safe and effective. It has the advantages of less trauma and faster recovery and can be used as the first choice for the treatment of ureter after IVC. However, long-term efficacy still need large sample controlled studies and long-term follow-up observation.