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目的:探讨改良气膀胱腹腔镜行Cohen输尿管再植术治疗输尿管末端狭窄的临床效果。方法:回顾分析2018年1月至2019年5月我院应用改良气膀胱腹腔镜Cohen输尿管再植术治疗输尿管末端狭窄患儿12例，年龄(3.0±2.2)岁，年龄范围1.2～9.5岁。其中，男8例，女4例，病变位于左侧9例，右侧3例。术中建立气膀胱后，经尿道于患侧输尿管开口内置入输尿管支架管，通过支架管指引输尿管末端的游离；切除狭窄段输尿管并取出；再次经尿道置入支架管及硅胶化疗管，化疗管继续置入患侧输尿管内，支架管末端与输尿管末端缝合并牵引，助手于体外牵引支架管，对输尿管末段进行精准裁剪及成形，经化疗管管腔置入双J管管芯，引导双J管置入，完成Cohen输尿管再植术。术后定期复查尿常规、泌尿系彩超及排泄性膀胱尿道造影(VCUG)、磁共振泌尿系统造影(MRU)、利尿肾图及肾静态显像，评估肾积水、输尿管扩张或狭窄、是否输尿管反流及肾脏功能参数等指标。结果:12例手术均获得成功，无中转开放手术。手术时间(99.0±16.1)min ，时间范围75～125 min。留置导尿管(7.0±1.5)d ，时间范围5～10d。留置膀胱造瘘管(12.3±1.3)d ，时间范围10～14d。术后住院天数(9.5±2.8)d，时间范围6～15d。术后随访(10.4±2.8)个月，时间范围6～16个月。术后6个月患侧肾盂前后径[(0.49±0.21)cm比(1.35±0.32)cm]、输尿管最大径[(0.66±0.21)cm比(1.77±0.33)cm]较术前均明显减小，差异具有统计学意义(n P<0.05)，肾静态显像提示患侧肾功能较术前上升或无明显变化，利尿肾图未发现机械性梗阻曲线，无腰痛及尿路感染发生，1例出现Ⅰ度反流，经过保守治疗后反流消失，无再次手术病例。n 结论:改良气膀胱腹腔镜Cohen输尿管再植术治疗输尿管末端狭窄是一种安全、有效的手术方式，手术操作简单，手术时间短，术后康复快。“,”Objective:To evaluate the clinical efficacy of modified air bladder laparoscope with Cohen ureteral replantation for terminal ureteral stenosis.Methods:From January 2018 to May 2019, retrospective analysis was performed for 12 children with terminal ureteral stenosis undergoing modified gas bladder laparoscopic Cohen ureteral retransplantation. There were 8 boys and 4 girls with an average age of (3.0±2.2)(1.2-9.5) years. The involved side was left (n n=9) and right (n n=3). Ureteral stent was inserted into ostium ureteris via transurethral route after gas bladder creating. Ureteral stricture was resected. After transurethral replacement of stent tube, the silicone tube for chemotherapy was implanted at the involved ureteral side. The ends of stent and silicone tubes were sutured with traction. With precision cutting and forming, double J tube core was placed for Cohen ureteral reimplantation. After operation, urine routine, ultrasound of urinary system, excretive cystourethrography (VCUG), magnetic resonance urography (MRU), diuretic nephrogram and static renal imaging were performed regularly for evaluating such parameters as hydronephrosis, ureteral dilatation or stenosis, ureteral reflux and renal function.n Results:All 12 cases were successfully operated without switching into open surgery. The average operative duration was (99.0±16.1)(75-125) min, the average indwelling period of catheter (7.0±1.5)(5-10) days, the average indwelling period of bladder fistula (12.3±1.3)(10-14) days, the average postoperative hospital stay (9.5±2.8)(6-15) days and the average postoperative follow-up period (10.4±2.8)(6-16) months. At Month 6 postoperatively, renal pelvic anterioposterior diameter [(0.49±0.21) vs (1.35±0.32)cm]and maximal ureteral diameter [(0.66±0.21) vs (1.77±0.33) cm]of the involved side shrank markedly as compared with pre-operation. The differences were statistically significant (n P<0.05). Renal static imaging indicated higher or unchanged renal function of the involved side. Diuretic renography revealed no mechanical obstruction curve, no back pain or urinary tract infections. One case of degree I reflux resolved after conservative measures. None was reoperated.n Conclusions:Modified gas bladder laparoscopic Cohen ureteral replantation is both safe and effective for ureteral terminal stenosis. It may simplify surgical procedures, shorten operative duration and recover quickly postoperatively.