輸尿管鏡輔助腹腔鏡輸尿管狹窄切除及吻和手術：影像及臨床經驗
洪晟鈞、裘坤元、程千里、歐宴泉、賀昊中、王賢祥、陳卷書、李建儀、楊晨洸
台中榮民總醫院外科部泌尿外科
Ureteroscopy-assisted laparoscopic segmental resection of ureteral stricture with a modified flank position: video demonstration and clinical experience
Sheng-chun Hung, Kun-Yuan Chiu, Chen-Li Cheng, Yen-Chuan Ou, Hao-Chung Ho, Shian-Shiang Wang, Chuan-Shu Chen, Jian-Ri Li, Chun-Kuang Yang
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Purpose：To share the surgical technique that with the advantage of perioperative ureteroscope without position change, laparoscopic segmental resection of ureteral stricture could be performed more precisely.
Patients and Methods：From 2006 January to 2015 December, 10 patients with ureteral stricture received laparoscopic segmental resection and ureteroureterostomy in our hospital. Etiology includes stone, endometriosis, crossing vessel and idiopathic benign ureteral polyp. With the advance of bilateral lower extremities extended and abduct, one assistant could use ureteroscope direct guide the precise location of the stricture affected ureter. Thus operator could make a more specific resection without unnecessary excision that may compromise the blood supply or increase the tension at anastomosis.
Results：5 patients received traditional transperitoneal laparoscopic approach and the other 5 patients received ureteroscope assisted laparoscopic segmental resection and ureteroureterostomy. Operation time was higher in the ureteroscopy assisted group (214minutes vs. 146 minutes, p<0.001). After at least one year of follow up, only one patient in traditional laparoscpic group suffered from recurrence. Video demonstrate one patient with right ureteral stricture due to stone impaction and with the advantage of ureteroscope guide without change position, operator could make a limited excision at affected part and for anastomosis. No complication related to the decubitus and bilateral leg extended position was noted.
Conclusions：Ureteroscopy assisted laparoscopic segmental resection of ureter without change position is a feasible and safe procedure in deal with refractory ureter stricture. Although it’s convenient, operator should aware of possible pressure sore at dependent part.