Retroperitoneal laparoscopic managent of gaint juvenile ureteral fibroepithelial polyps
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摘要: 目的:探讨经后腹腔镜息肉段输尿管切除术加端端吻合治疗广基输尿管息肉的疗效和手术技巧。方法:回顾性分析2007年3月~2011月11月间采用后腹腔镜治疗广基大体积输尿管息肉患者15例,其中完整切除输尿管息肉基底所在部分肾盂和输尿管并行肾盂输尿管成形术12例,切除息肉段输尿管行输尿管端端吻合术3例。结果:15例输尿管息肉均通过腹腔镜手术成功治疗,其中1例患者行分期手术治疗,无术中并发症发生,没有需要中转开放手术的病例。息肉平均长度为10.1 cm(5~17 cm),平均手术时间为125.9 min,平均术后住院时间为3.75天。于术后6~12周移除双J管。随访时间为12~24个月。随访期间,B超及肾分泌性造影未见息肉复发。所有患者病检报告均为良性纤维上皮性息肉。结论:经后腹腔镜息肉段输尿管切除术加端端吻合治疗广基输尿管息肉安全有效,并发症少。彻底切除病变所在输尿管或肾盂保证了其长期疗效。Abstract: Objective:The experience with laparoscopic management of large(mean length 10.1 cm) ureteral fibroepithelial polyps using retroperitoneal approach was reviewed to evaluate its effectiveness and safety.Methods:Between March 2007 and October 2011, a total of 15 patients were successfully treated with laparoscopy. The mean age of the patients was 17.3 years (range 15-21 years). The segment of the ureter or UPJ area containing the polyp was completely removed, followed by laparoscopic dismembered pyeloplasty or uretero-ureteral anastomosis.Results:Laparoscopic management was successful in all 15 cases, and no major complications resulted from the approach. Mean polyp length was 10.1 cm(range 5-17 cm). Mean operative time in the unilateral cases was 125.9 minutes. Mean hospital stay was 3.75 days. The Double J stent was removed at 6 to 12 weeks. Followup ranged from 12 to 24 months. No recurrent polyps were seen on followup B-mode ultrasound or excretory urography. Pathologic findings demonstrated a benign fibroepithelial polyp.Conclusions:Laparoscopy as a minimally invasive approach may offer a safe and effective modality with minimal morbidity and durable treatment results for large ureteral polyps. Destruction of the ureteral base,the stalk and entire polyp may guarantee the long term curative effect.
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