双荧光腹腔镜在舌黏膜修复复杂输尿管狭窄手术中的应用

Application of dual fluorescence laparoscopy in the repair of complex ureteral stricture with lingual mucosa graft

摘要

目的 评估双荧光腹腔镜定位输尿管狭窄段及其血供情况的可行性及有效性，为复杂输尿管狭窄的治疗提供新思路，帮助手术医生提高输尿管重建手术的效率和成功率。方法 本团队开发了双荧光腹腔镜系统，可同时通过输尿管内注射亚甲蓝（MB）定位输尿管狭窄段以及通过静脉注射吲哚菁绿（ICG）判断输尿管断端血供情况。结果 本文回顾性分析了3例于武汉大学中南医院利用双荧光腹腔镜进行舌黏膜输尿管成形手术的患者资料，3例患者的手术均顺利完成，手术时间分别为144、132和163 min，获取的舌黏膜长度分别为2.0、2.8和3.5 cm，术中及术后均无并发症发生，术后8周输尿管顺行造影显示输尿管通畅。结论 双荧光腹腔镜在舌黏膜修复复杂输尿管狭窄手术中安全可行，为复杂输尿管重建提供了新的技术方案。

Abstract

Objective To evaluate the feasibility and effectiveness of dual fluorescence laparoscopy in the localization of ureteral stricture and its blood supply, and to provide a new idea for the treatment of complex ureteral stenosis, thus helping doctors to improve the efficiency of ureteral reconstruction surgery. Methods Our team developed a dual fluorescence laparoscopic system, which could simultaneously identify the ureter stricture by intra-ureteral injection of methylene blue (MB) and assess the blood supply of the ureteral stumps by intravenous injection of indocyanine green (ICG). Results The clinical data of 3 patients who underwent lingual mucosa ureteroplasty using dual fluorescence laparoscopy in Zhongnan Hospital of Wuhan University were retrospectively analyzed. All operations were successful, without conversion to open surgery. The operation time was 144, 132 and 163 minutes, respectively. The length of harvested lingual mucosa graft was 2.0, 2.8 and 3.5 cm, respectively. No intraoperative or postoperative complications occurred. Eight weeks after operation, ureterography showed that the ureter was unobstructed. Conclusion Dual fluorescence laparoscopy is safe and feasible in the repair of complex ureteral stricture with lingual mucosa graft, which provides a new idea for complex ureteral reconstruction.

关键词

输尿管狭窄 / 双荧光腹腔镜 / 输尿管修复重建 / 亚甲蓝 / 吲哚菁绿

Key words

ureteral stricture / dual fluorescence laparoscopy / repair and reconstruction of ureteral stricture / methylene blue / indocyanine green

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