探讨腹腔镜下乳头式输尿管膀胱再植术的手术技巧及临床疗效。

回顾性分析我院2013年8月至2017年6月行腹腔镜下乳头式输尿管膀胱再植术28例患者临床资料及手术视频。男12例，女16例，左侧15例，右侧12例，双侧1例。巨输尿管症22例，输尿管开口异位3例，医源性损伤3例。年龄8～48岁，平均（31±9）岁。28例均行经腹途径腹腔镜下乳头式输尿管膀胱再植术，术中将输尿管牵拉出体外裁剪。

手术均成功，无中转开放病例。手术时间65～150 min，平均（96±26）min，出血10～40 ml，平均（25±8）ml，术后住院4～7 d，平均（5.8±1.2）d，术后无漏尿，引流管3～5 d拔出，尿管留置1周，输尿管支架管留置45 d。术后随访6～24个月，行超声及CT检查，其中25例肾积水较术前不同程度减轻，2例较术前无加重，膀胱排泄性尿路造影未见输尿管返流，给予动态观察；1例进行性加重，造影提示吻合口狭窄，给予行球囊扩张后好转。

腹腔镜下乳头式输尿管膀胱再植手术安全、简单、高效、抗返流效果好，值得推广。

To explore the clinical efficacy and operation techniques of 1aparoscopic extravesical ureteral nipple reimplantation.

The clinical data of 28 cases with abnormal lower end ureter undergone 1aparoscopic extravesical ureteral nipple reimplantation from August 2013 to June 2017 were reviewed. There were 12 males and 16 females, age from 8 to 48 years, 12 cases on right side, 15 cases on left side and one cases on both sides. Including 22 cases of megaureter, 3 cases of congenital ectopic ureteral orifice and 3 cases of iatrogenic ureteral injuries.

All operations were successful in the 28 patients without open conversion. The mean operative duration was (96±26, 65-150) minutes.The mean blood loss was (25±8, 10-40) ml. The mean hospital stay was (5.8±1.2, 4-7) days. The preserved time of installing catheter after operation was 1 week. The double J was preserved about 45 days and no anastomotic leakage of urine after surgery. Urinary ultrasonography, urinary computed tomography (CT) were performed after operation. The postoperative follow-up period was 6-24 months. At 3 months postoperation, the hydronephrosis decreased in twenty-five cases and had no obvious change in two cases. But the hydronephrosis exacerbated gradually in one case with anastomotic narrow. Balloon dilatation was performed to solve it eventually.

Laparoscopic extravesical ureteral nipple reimplantation is safe, efficacious and simplified for abnormal lower end ureter. And this technique is worth to popularize.