使用颊粘膜移植进行腹腔镜膀胱颈重建

这是一名 60 岁男性的病例，两年前他接受了双极经尿道前列腺切除术 (TURP)。患者出现膀胱颈硬化，并出现严重的尿路阻塞和衰竭，通过两次内窥镜手术治疗。膀胱镜检查显示尿道直至膀胱连接处均正常。医生决定采用经膀胱腹腔镜技术，使用颊黏膜移植进行前路重建。

(a) 排尿和逆行膀胱尿道造影显示狭窄仅限于膀胱颈。(b) 柔性膀胱镜检查显示膀胱颈挛缩、前列腺窝宽大和精阜。

在全身麻醉下，患者仰卧。监视器放在患者两腿之间，尽可能靠近外科医生的视线水平。右撇子外科医生站在患者左侧，助手站在患者对面。然后将 10 毫米套管针插入脐部，以便 30° 腹腔镜通过。插入另外两个套管针：左髂窝 5 毫米套管针和右髂窝麦氏点 10 毫米套管针（图 2）。


三孔腹膜外入路。


T 形切开膀胱前壁。


切开狭窄的膀胱颈，使管腔变宽，以便 Fr20 尿道扩张器可以轻松穿过。


从远端到近端放置间断 3/0 聚乳酸缝合线（箭头指向前盆壁）。


(a) 术后尿流率测定显示钟形曲线；(b) 术后膀胱尿道造影显示吻合口宽。

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