CAJ | 학술논문

目的：探讨后腹腔镜输尿管复位矫形术治疗下腔静脉后输尿管的效果。方法2007年1月～2013年12月，对9例下腔静脉后输尿管施行后腹腔镜输尿管复位矫形术。后腹腔镜下游离肾盂、输尿管至腔静脉后方，在腔静脉前方找到并游离远端输尿管，于下腔静脉压迫输尿管处上方离断输尿管，分离输尿管与下腔静脉的粘连，将远段输尿管复位至腔静脉前方。3例远段输尿管从下腔静脉后游离困难，旷置下腔静脉后输尿管狭窄段。输尿管内留置F7双J管，输尿管端端吻合。结果本组均一次手术成功，无中转开放。手术时间56～120 min，平均75 min，术中出血量20～150 ml，平均60 ml，术中术后均未输血，肛门排气时间16～48 h，术后无尿漏发生，4～5 d拔除腹膜后引流管，5～6 d拔除导尿管，2例伴肾盂结石患者术后尿路平片提示结石取净，4～8周膀胱镜拔除双J管。随访6～72个月，平均36个月，6例术前有右腰部疼痛不适的症状均消失，彩超及IVU示右输尿管走向恢复正常，大剂量IVU法6例肾积水Ⅲ～Ⅳ度降为Ⅰ度，3例肾积水消失。结论后腹腔镜输尿管复位矫形术治疗下腔静脉后输尿管是安全、有效、可行的，具有创伤小、失血少、术后疼痛轻、住院时间短、疗效可靠等优点，有望成为治疗下腔静脉后输尿管首选的方法。
목적：탐토후복강경수뇨관복위교형술치료하강정맥후수뇨관적효과。방법2007년1월～2013년12월，대9례하강정맥후수뇨관시행후복강경수뇨관복위교형술。후복강경하유리신우、수뇨관지강정맥후방，재강정맥전방조도병유리원단수뇨관，우하강정맥압박수뇨관처상방리단수뇨관，분리수뇨관여하강정맥적점련，장원단수뇨관복위지강정맥전방。3례원단수뇨관종하강정맥후유리곤난，광치하강정맥후수뇨관협착단。수뇨관내류치F7쌍J관，수뇨관단단문합。결과본조균일차수술성공，무중전개방。수술시간56～120 min，평균75 min，술중출혈량20～150 ml，평균60 ml，술중술후균미수혈，항문배기시간16～48 h，술후무뇨루발생，4～5 d발제복막후인류관，5～6 d발제도뇨관，2례반신우결석환자술후뇨로평편제시결석취정，4～8주방광경발제쌍J관。수방6～72개월，평균36개월，6례술전유우요부동통불괄적증상균소실，채초급IVU시우수뇨관주향회복정상，대제량IVU법6례신적수Ⅲ～Ⅳ도강위Ⅰ도，3례신적수소실。결론후복강경수뇨관복위교형술치료하강정맥후수뇨관시안전、유효、가행적，구유창상소、실혈소、술후동통경、주원시간단、료효가고등우점，유망성위치료하강정맥후수뇨관수선적방법。
Objective To evaluate the efficacy of retroperitoneal laparoscopic ureteroplasty for retrocaval ureter . Methods From January 2007 to December 2013, 9 patients with retrocaval ureter underwent retroperitoneal laparoscopic ureteroplasty .The renal pelvis and ureter were separated from the vena cava .The ureter was founded and dissected in the front of the vena cava and cut off above the place where ureter was oppressed by vena cava .The distal ureter was placed to the front of the vena cava after the dissociation.The ureteral stenosis was left aside for difficult separation of distal ureter from the vena cava in 3 patients.A F7 double-J stent was put inside the ureter before the end-to-end anastomosis of the ureter . Results All the patients underwent the surgery successfully without conversion to open operation .The mean operation time was 75 min (range, 56-120 min), and the mean blood loss was 60 ml (range, 20-150 ml) without any blood transfusion.The time of gastrointestinal function recovery was 16-48 h, and no urethral leakage occurred .Retroperitoneal tube and catheter were removed in 4 -5 days and 5 -6 days after the operation , respectively.The kidney stones in 2 patients were removed during the operation .The double-J stent was removed at 4 -8 weeks. During the follow-up of 6-72 months, the symptoms of osphyalgia disappeared .IVU and ultrasonography showed normal shape of right ureter.Hydronephrosis was improved from Ⅲ-Ⅳ degree to Ⅰ degree in 6 patients and was cured in 3 patients. Conclusions Retroperitoneal laparoscopic ureteroplasty for retrocaval ureter is safe and effective .Based on its fewer trauma , less blood loss , less pain, shorter hospital stay, and reliable effects, retroperitoneal laparoscopic ureteroplasty is considered to replace traditional operation and be the first choice of the treatment of retrocaval ureter .