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纸质出版:2014
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习林云,何大维,刘星,华燚,刘俊宏,刘丰,林涛,魏光辉.气膀胱腹腔镜改良Glenn-Anderson输尿管膀胱再植术对66例膀胱输尿管连接部畸形患儿的疗效观察[J].陆军军医大学学报(原第三军医大学学报),2014,36(20):2125-2128.
Xi Linyun,He Dawei,Liu Xing,Hua Yi,Liu Junhong,Liu Feng,Lin Tao,Wei Guanghui.Modified pneumoeystoscopic Glenn-Anderson ureter reimplantation: report of 66 children[J].J Amry Med Univ (J Third Mil Med Univ),2014,36(20):2125-2128.
习林云,何大维,刘星,华燚,刘俊宏,刘丰,林涛,魏光辉.气膀胱腹腔镜改良Glenn-Anderson输尿管膀胱再植术对66例膀胱输尿管连接部畸形患儿的疗效观察[J].陆军军医大学学报(原第三军医大学学报),2014,36(20):2125-2128. DOI:
Xi Linyun,He Dawei,Liu Xing,Hua Yi,Liu Junhong,Liu Feng,Lin Tao,Wei Guanghui.Modified pneumoeystoscopic Glenn-Anderson ureter reimplantation: report of 66 children[J].J Amry Med Univ (J Third Mil Med Univ),2014,36(20):2125-2128. DOI:
目的 总结应用气膀胱腹腔镜改良Glenn-Anderson输尿管膀胱再植术治疗膀胱输尿管连接部畸形的手术方法及治疗效果。 方法 选取2006年2月至2013年2月于本院收治的66例膀胱输尿管连接部畸形的患儿,年龄2个月至14岁,中位年龄为4.5岁。其中原发性膀胱输尿管反流12例,双侧2例,单侧10例。膀胱输尿管连接部狭窄54例,双侧4例,单侧50例。原发性膀胱输尿管反流伴反复尿路感染3例,膀胱输尿管连接部狭窄伴反复尿路感染者2例。66例均在气膀胱腹腔镜下行改良Glenn-Anderson术。所有患儿均留置导尿管,不做膀胱造漏。术后6 d拔除支架管,B超随访输尿管及肾积水程度变化,尿常规了解有无尿路感染,输尿管扩张者行排尿性膀胱尿道造影了解是否有输尿管反流。 结果 1例(1.5%)因观察镜套管滑脱再次建立气膀胱漏气而中转开放。手术时间70~200 min,平均125 min,单侧手术平均时间为95 min,双侧手术平均时间为136 min。无伤口感染、尿路感染等并发症,膀胱穿刺孔出血1例。65例均痊愈出院,术后随访12个月。术后3、6、12个月输尿管无扩张比例分别为80%、89%、95%,未观察到输尿管直径加重病例。术后12个月3根(5.3%)输尿管仍扩张者,行排尿性膀胱尿道造影证实分别为Ⅰ、Ⅲ级反流,尿常规提示无尿路感染。 结论 气膀胱腹腔镜下改良Glenn-Anderson术治疗膀胱输尿管连接部畸形可取得良好的手术效果,同时具有微创优势,且不受年龄限制,是一种安全、有效、低并发症的手术方式。
Objective To describe the clinical efficacy of modified pneumoeystoscopic Glenn-Anderson ureter reimplantation for congenital malformation of vesicoureteral junction in children. Methods A total of 66 children (aged from 2 months to 14 years
median 4.5 years ) with congenital malformation of the vesicoureteral junction in our department from February 2006 to February 2013 were enrolled in this study. Among the patients
12 had vesicoureteral reflux (2 bilateral) and 54 had congenital vesicoureteral junction obstruction (4 bilateral). Two of the congenital vesicoureteral junction obstruction and 3 of the vesicoureteral reflux had recurrent urinary infection. All of the patients underwent modified Glenn-Anderson ureter reimplantation. A Foley catheter was indwelled in each patient but no bladder fistula was made. The stenting catheters were removed in 6 d after surgery. B-scan ultrasonography was used to follow the degree of the dilatation of ureter and hydronephrosis. Urinalysis was used to detect the urinary tract infection. Voiding cystourethrography was used in the patients with dilated ureters to show ureteral reflux. Results The procedure was completed in all but 1 patient
who was converted to open surgery because of gas leakage led by displacement of the port. The mean operation time was 125 min (70 to 200 min)
95 min (70 to 140 min) for unilateral cases and 136 min (110 to 200 min) for bilateral cases. All patients were free from complications such as surgical site infection or urinary tract infection. One case of bladder port side bleeding was observed. The ratio of no ureter dilation was 80%
89%
and 95% 3 months
6 months
and 12 months after surgery
respectively. No aggravated case was observed. Voiding cystourethrography showed I and Ⅲ degree urine reflux in 1 bilateral obstruction case and 1 unilateral cases 12 months after surgery with no urinary tract infection. Conclusion The modified pneumoeystoscopic Glenn-Anderson ureter reimplantation is a safe
effective option with few complications for congenital malformation of vesicoureteral junction in children.
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