| Objective:In this study,Our researches focus on evaluating the clinical efficacy of transperitoneal laparoscopic extravesical ureterovesical implantation under submucosal tunnel versus the open surgery during the corresponding time period.Then we can provide scientific proof for the promotion of laparoscopic extravesical ureterovesical implantation under submucosal tunnel.Method:20 cases of laparoscopic extravesical ureterovesical implantation under submucosal tunnel and 32 cases of the open surgery which had been prformed for ureterovesical obstruction in our hospital from October 2005 to October 2009 were retrospectively analyzed.We gathered the detailed clinical data of these patients,including name,sex,age,total operation time,blood loss,length of incision, time to oral liquids,time of intravenous antibiotic,time of drainage, time of postoperative analgesia,postoperation hospital stay,postoperative complications, hospital costs and postoperative recovery time to normal life.Then we did a comparative study of the main clinical indicators and evaluated clinical significance of the Laparoscopic ureteral reimplantation.Result:Laparoscopic ureteral reimplantation was completed in all 20 patients and no conversion to open conversion.The mean operative time (excluding anesthesia time) was 150.5minutes (range 85-240min).The mean drop in hemoglobin was 52mL(range 20-105mL) between preoperative and postoperative sampling.The mean length of incision was 3.5cm (range 3-4cm).The mean time of drainage was 3.2days.18 patients were discharged by pull out the drainage tube 2-5 days after surgery. However 2 patients with urine leakage were discharged by dressing change and pull out the drainage tube 7days after surgery.And no hydronephrosis aggravating. The mean time to oral liquids was 1.4days(range 1-3days) after surgery.The catheter was removed 14days later. Postoperative views in all patients was with a single dose of antibiotic after surgery for 4.6 days(range 2-8days).The mean time of postoperative analgesia was 0.8days (range 0-2days).The mean hospital costs was 13200yuan(range 9000-17000yuan).The mean hospital stay was 8days(range 5-12days) and the pig-tail catheter remained for an average of 3 months.The mean postoperative recovery time to normal life was 23.6days(range 16-35days).During 2-38 months'follow-up, Postoperative evaluation revealed good renal function and no ureteral stricture in all patients by B-US,IVU or CT examination.Postoperatively, ultrasonographic scanning in 13 patients showed no evidence of hydronephrosis, and in 6 patients, showed mild water of the pelvicaliceal collecting system,and in one patient,showed moderate water of the pelvicaliceal collecting system.3-6 months after surgery cystography showed urine reflux in one cases and no urine reflux in 19 cases.Open surgery was completed in all 32 patients.The mean operative time (excluding anesthesia time) was 131.4minutes (range 80-200min).The mean drop in hemoglobin was 152.5mL(range 80-230mL) between preoperative and postoperative sampling.The mean length of incision was 12.7cm (range 9-16cm).The mean time of drainage was 4.2days.27 patients were discharged by pull out the drainage tube 2-6 days after surgery. However 5 patients with urine leakage were discharged by dressing change and pull out the drainage tube 7 days after surgery.And no hydronephrosis aggravating. The mean time to oral liquids was 2.8days(range 2-4days) after surgery.The catheter was removed 14days later. Postoperative views in all patients was with a single dose of antibiotic after surgery for 7.2days(range 4-12days).The mean time of postoperative analgesia was 2.2days (range 0-4days).The mean hospital costs was 12900yuan(range 8000-17000yuan).The mean hospital stay was 11.7days(range 8-16days) and the pig-tail catheter remained for an average of 3 months.The mean postoperative recovery time to normal life was 30.1days(range 20-42days).During 2-38 months'follow-up, Postoperative evaluation revealed good renal function and no ureteral stricture in all patients by B-us,IVU and CT examination.Postoperatively, ultrasonographic scanning in 23 patients showed no evidence of hydronephrosis, and in 7 patients, showed mild water of the pelvicaliceal collecting system,and in 2 patients,showed moderate water of the pelvicaliceal collecting system.3-6 months after surgery cystography showed urine reflux in 3 cases and no urine reflux in 29 cases.Comparing the results of laparoscopic extravesical ureterovesical implantation under submucosal tunnel with open surgery,the age, the sex, the degree of hydronephrosis and the hospital costs were no significant differences,while the mean operative time were statistically significant different.The mean operative time of the laparoscopic approach was more than the open approach.But the mean volume of blood loss,length of incision, time to oral liquids,time of intravenous antibiotic,time of drainage,postoperation hospital stay,the postoperative complications and postoperative recovery time to normal life were statistically significant different.The laparoscopic approach was more minimally invasive than the open approach in the operation of b ladder-flag ureterovesical implantation.Conclusion:The mean operative time of the laparoscopic extravesical ureterovesical implantation under submucosal tunnel is more than the open approach, but with the development of laparoscopic surgery and Laparoscopic procedure, the operative time was shortened little by little or even close to the open surgery.Laparoscopic extravesical ureterovesical implantation under submucosal tunnel is not only a safe and feasible procedure with many operative indications,but has minimal invasion, less suffering and complications,shorter hospitalization and convalescence, excellent anti-urine reflux effect and expectant long-term outcomes.It has a clinical significance and expectant promotion comparable to open surgery about the postoperative complications and outcomes of the procedure. quicker recovery. It plays an important role in the treatment of ureterovesical junction obstruction.
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