倒刺线连续缝合法在耻骨上辅助经脐单孔腹腔镜插入式输尿管膀胱再植术中的应用

王晓宁; 张国玺; 袁源湖; 邹晓峰; 肖日海; 伍耿青; 薛义军; 龙大治; 吴玉婷; 刘佛林; 刘敏; 徐辉; 杨军; 廖云峰; 徐刚

doi:10.13201/j.issn.1001-1420.2015.05.006

倒刺线连续缝合法在耻骨上辅助经脐单孔腹腔镜插入式输尿管膀胱再植术中的应用

- 1. 赣南医学院第一附属医院泌尿外科赣南医学院泌尿外科研究所(江西赣州, 341000);
- 2. 赣南医学院泌尿外科研究所
基金项目:
国家高技术研发计划（863计划）项目（编号2012AA021100）；江西省”赣鄱英才555工程”领军人才培养计划项目；江西省科技厅重大科技支撑计划项目（编号20121BBG70032；20132BAB205007）；江西省卫生厅重大科技计划项目（编号20104008）；江西省教育厅科技落地计划项目（编号KJLD12044）

详细信息

通讯作者: 邹晓峰,E-mail:gyfyurology@126.com

中图分类号: R572

收稿日期: 2015-01-10

Application of continuous self-retaining suture in suprapubic-assisted laparoendoscopic single-site surgery for inserting ureteral reimplantation

- Department of Urology, First Affiliated Hospital of Gannan Medical University;Institute of Urology, Gannan Medical University, Ganzhou, Jiangxi, 341000, China

More Information

Corresponding author: ZOU Xiaofeng, E-mail: gyfyurology@126.com

Received Date: 10 January 2015

摘要

摘要: 目的：评价倒刺线连续缝合法在耻骨上辅助经脐单孔腹腔镜（SA-LESS）插入式输尿管膀胱再植术中的应用价值。方法：2012年1月~2014年9月实施SA-LESS插入式输尿管膀胱再植术21例，男9例，女12例。输尿管末端狭窄16例，巨输尿管症2例，输尿管阴道瘘2例，重复输尿管异位开口1例。左侧14例，右侧7例。患者全麻，取平卧头低脚高位。分别于脐缘置入10 mm、5 mm Trocar及操作器械，健侧耻骨联合上阴毛覆盖区置入5 mm套管及5.4 mm 0°远端可弯曲腹腔镜。游离输尿管下段，于病变近端切断。输尿管内留置双J管，切开膀胱侧后顶壁，行插入式输尿管膀胱再植。按吻合方法不同分为两组，A组11例采用新型双向带倒刺缝合线行连续缝合，B组10例采用单针薇荞线行间断缝合。结果：21例21侧手术均顺利完成，无大出血、尿瘘、腹腔感染等严重并发症发生。A组手术时间、术中输尿管膀胱吻合时间均低于B组（P<0.01）。两组术中出血量、术后引流管留置时间、肠道功能恢复时间、并发症发生率等差异无统计学意义（P>0.05）。随访3~36个月，患侧肾输尿管积水好转或消失，无膀胱输尿管反流、吻合口狭窄发生。结论：SA-LESS插入式输尿管膀胱再植术安全、有效，美容效果佳；术中应用倒刺线连续缝合，无需打结，显著降低了操作难度，缩短了手术时间，值得临床推广应用。
- 腹腔镜术 /
- 单孔 /
- 耻骨联合 /
- 输尿管膀胱吻合 /
- 可吸收缝线
Abstract: Objective: To evaluate the value of continuous self-retaining suture (QUILL SRS) in suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) for inserting ureteral reimplantation.Method: From January 2012 to September 2014, 21 cases including 9 males and 12 females underwent SA-LESS inserting ureteral reimplantation. Among them, distal ureter stricture existed in 16 cases, megaureter in 2 cases, uretero-vaginal fistula in 2 cases, repeat ectopic ureter in 1 case. There were 14 cases on the left side, 7 cases on the right side. Under general anesthesia, the patients were placed in Trendelenburg position. One 5- and 10-mm trocars were inserted into the umbilical edge. A 5-mm trocar was inserted into abdominal cavity below the pubic hairline, through which a 5.4-mm 0° flexible-tip laparoscope was placed. The ureter was resected at the upper obstruction, and was reimplanted into the bladder directly with the terminal in the bladder at 1-1.5 cm length. According to the method of anastomosis, the patients were divided into two groups (A=11, B=10). Patients in group A underwent continuous suture with QUILL SRS, and those in group B underwent interrupted suture with Vicryl suture.Result: Twenty one procedures were completed successfully without complications such as massive haemorrhage, urinary fistula or serious abdominal infection. The time of operation and ureterocystoneostomy in group A was shorter than that of group B (P<0.01). There was no statistically significant difference in the intraoperative estimated blood loss, postoperative drainage tube indwelling time, intestinal function recovery time, or rate of complication between the two groups (P>0.05). During the follow-up period of 3-36 months, hydronephrosis disappeared or reduced, and no ureter stenosis or reflux occurred.Conclusion: SA-LESS inserting ureteral reimplantation is safe and effective. The technique of continuous suture with QUILL SRS can make operation easier, reduce operative time significantly and provide a good cosmetic result. Thus, it is worthy of clinical application.
- laparoendoscopy /
- single-site /
- pubic symphysis /
- ureterocystoneostomy /
- absorbable suture

HTML全文

参考文献(15)

[1]	贾卓敏, 艾星, 关亚伟.腹腔镜下输尿管膀胱再植术治疗梗阻性巨输尿管的临床应用[J].中华泌尿外科杂志, 2014, 35(4):270-273.
[2]	韩金利, 黄健, 许可慰, 等.经脐单孔腹腔镜乳头式输尿管膀胱再植术初步体会[J].中山大学学报(医学科学版), 2010, 31(3):448-450.
[3]	Roslan M, Markuszewski M M, Kłacz J, et al.Laparoendoscopic single-site transvesical ureteroneocystostomy for vesicoureteral reflux in an adult:a one-year follow-up[J].Urology, 2012, 80(3):719-723.
[4]	邹晓峰, 张国玺, 袁源湖, 等.耻骨上辅助经脐单孔腹腔镜技术在泌尿外科的应用价值(附57例报告)[J].临床泌尿外科杂志, 2011, 26(7):481-484.
[5]	Zou X F, Zhang G X, Xue Y J, et al.Suprapubic-assisted laparoendoscopic single-site surgery(LESS) in urology:our experience[J].BJU Int, 2013, 112(2):E92-98.
[6]	钟辛, 江波, 邹晓峰, 等.双J管置入器在腹腔镜上尿路切开取石术中的应用[J].临床泌尿外科杂志, 2013, 28(12):903-905.
[7]	孙颖浩, 吴震杰.泌尿外科单孔多通道腹腔镜技术在中国的应用与创新[J].中华泌尿外科杂志, 2012, 33(10):729-734.
[8]	王晓宁, 袁源湖, 肖日海, 等.三种腹腔镜肾盂输尿管切开取石术治疗孤立肾上尿路结石的疗效比较[J].临床泌尿外科杂志, 2013, 28(12):884-888.
[9]	邹晓峰, 廖云峰, 张国玺, 等.耻骨上辅助经脐单孔腹腔镜上尿路全切除术(附8例报告)[J].临床泌尿外科杂志, 2013, 28(6):401-404.
[10]	Stanasel I, Atala A, Hemal A.Robotic assisted ureteral reimplantation:current status[J].Curr Urol Rep, 2013, 14(1):32-36.
[11]	杨玻, 范治璐.腹腔镜"漂浮法"输尿管膀胱再植的临床应用[J].临床泌尿外科杂志, 2008, 23(10):740-741.
[12]	Weld K J, Ames C D, Hruby G, et al.Evaluation of a novel knotless self-anchoring suture material for urinary tract reconstruction[J].Urology, 2006, 67(6):1133-1137.
[13]	陈杰, 徐必友, 徐丹枫, 等.新型双向倒钩免打结缝合线在肾门部肿瘤腹腔镜下肾部分切除术中的应用[J].微创泌尿外科杂志, 2014, 3(2):84-87.
[14]	朱捷, 高江平, 徐阿祥, 等.机器人辅助腹腔镜输尿管非乳头再植术[J].临床泌尿外科杂志, 2010, 25(6):405-407.
[15]	Khanna R, Isac W, Laydner H, et al.Laparoendoscopic single site reconstructive procedures in urology:medium term results[J].J Urol, 2012, 187(5):1702-1706.