The Clinical Application Of Pneumocystoscopic And Open Surgery Cohen Ureteric Reimplantation

Objective:In this study,Our researches focus on evaluating the clinical efficacy of pneumocystoscopic Cohen ureleric reimplanlation versus the open surgery. And introduce indication, the surgical approach,intraoperation considerations, c1inical efficacy, postoperative complications of pneumocystoscopic Cohen ureleric reimplantation. Then we can provide scientitic experience for the promotion of pneumocystoscopic Cohen ureteric reimplantation.Materials And Methods:12cases of pneumocystoscopic Cohen ureleric roimplantation and17cases of the open surgery which had been performed for ureterovesica1obstruction in our hospital from January2010to December2012were retrospectively analyzed. Compared the operative lime, blood loss, incision1ength, postoperative hemaluria time, fasting time, using intravenous antibiotic’s time,postoperative hospital stay,postoperative complications and so on of the two groups.Review relevant literature and evaluate pneumocystoscopic Cohen ureleric reimplantation’s clinical effects and indications.Result:Laparoscopic ureteral reimplantation was completed in10patients and2conversion to open conversion.The mean operative time was178.75minutes (range135～275min). The mean drop in hemoglobin was5.63mL(range5～10mL) between preoperative and postoperative sampling. The mean length of incision was1.81cm(range1.5～2cm). The mean time of postoperative hematuria was2.25days (range1～3days). The mean fasting time was0.82days(range0～1days).The mean time of using intravenous antibiotic was8.13days(range6～10days). The mean time of urine tube indwelling duration was9.75days(range7～12days).None of the cases indwelled bladder fistula and drainage tube.The mean time of postoperative hospital stay was10.50days(range8～14days). Remove the double J tube and then do physical examination and review the renal function, cystography, urinary B or MRU.1of10appeared hematuria and improved after antibiotic therapy. The case of the ureteral stones was cured. None of the cases appeared the symptoms of fever, hematuria and waist uncomfortable. ALL cases’ renal function was normal. Cystography showed no vesicoureteral reflux. B ultrasonic and MRU showed hydronephrosis and hydroureter significant improvement. Then follow up for3months to2years regularly, there were no reflux by checking cystography. Urinary B or MRU showed hydroureter improved significantly. Laparoscopic ureteral reimplantation could achieve the effect of open surgery fully.2cases of 12converted to laparotomy because of the small bladder capacity.All Crises of the open operation were successful. The mean operative time was88.24minutes (range55~150min).The mean drop in hemoglobin was10.29mL(range5～20mL) between preoperative and postoperative sampling. The mean length of incision was9.45cm(range8～l0cm). The mean time of postoperative hematuria was3.41days(range l"8days). The mean fasting time was2.64days(range2~3days).The mean time of using intravenous antibiotic was13.06days(range7～l8days).The mean time of urine tube indwelling duration was12.18days(range9～l5days). The mean time of indwelled bladder fistula was11.6days(range7～18days).The mean time of indwelled drainage tube was5.4days(range413days).3cases appeared leakage of urine and improved after removal of the drainage tube delay. The mean time of postoperative hospital stay was15days (range10～25days). Remove the double J tube and then do physical examination and review the renal function,cystography, urinary B or MRU. ALL cases’ renal function was normal.Cystography showed no vesicoureteral reflux. B ultrasonic and MRU showed hydronephrosis and hydroureler significant improvement. Then follow up for3months to2years regularly, there were no reflux by checking cystography.Urinary B or MRU showed hyclroureter improved significantly.Comparing the results of pneumocystoscopic Cohen ureteric reimplantation with open surgery, the sex, the degree of hydroureter, clinical efficacy and the postoperative complications were no significant differences, while the age and the mean operative time was statistically significant different. The mean operative time of the laparoscopic approach was more than the open approach and the mean age of the laparoscopic approach was older than the open approach. But the mean postoperative fasting time,volume of blood loss, length of incision, time of intravenous antibiotic, time of drainage and postoperation hospital stay were statistically significant different. The laparoscopic approach was better than the open approach.Conclusion:The pneumocystoscopic Cohen ureteric reimplantation is not only a safe and feasible procedure compared to open operation, but has less suffering, minimal invasion and less complications. Generally do not need to suprapubic cystostomy, and only to indwell catheter.It also has less damage to the bladder wall.It has a clinical significance and expectant promotion compared 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.The mean operative time of the pneumocystoscopic Cohen ureteric reimplantation is more than the open approach, but with the development of laparoscopic surgery and Laparoscopic procedure, the operative time will be shortened or even close to the open surgery. We should know the indications of the pnoumocystoscopic vesicoureteral reimplantation.