目的:通过改良插入式乳头法对15例输尿管末段狭窄的患者施行腹腔镜输尿管膀胱再植术,并对临床效果进行分析。方法:本组15例患者,术前诊断均为输尿管末段狭窄,其中男5例,女10例,平均年龄37.5岁。术前超声、IVU、CTU等检查提示上尿路扩张积水Ⅳ~Ⅴ级。所有病例均采用经腹腔途径,手术要点包括输尿管游离和离断、输尿管自Trocar孔拉出体外行乳头成形和双J管置入、再放回腹腔行输尿管膀胱再植。结果:15例患者手术均顺利完成,平均手术时间159.7min,术中平均失血量76ml,术后引流管引流量平均170ml;术后随访3~12个月,影像学改善率100%,积水完全消失3例,积水等级降为Ⅰ级10例,降为Ⅱ级2例。2例患者出现无症状、无需特殊处理的Ⅰ度输尿管反流。结论:改良插入式乳头法行腹腔镜输尿管膀胱再植术是安全、可靠和简便有效的手术方法。 OBJECTIVE: To evaluate the clinical effect of laparoscopic ureter bladder replantation in 15 patients with stenosis of distal ureter by modified insert nipple method. Methods: The group of 15 patients, preoperative diagnosis of distal ureteral stenosis, including 5 males and 10 females, with an average age of 37.5 years. Preoperative ultrasound, IVU, CTU and other tests suggest that the upper urinary tract expansion of water Ⅳ ~ Ⅴ level. All cases were treated by transperitoneal approach. The main operative points included the free and broken ureter, the ureter pulled out from the Trocar hole, and the nipple was placed in vitro and inserted into the double J tube. The ureter was replanted into the abdominal cavity for replantation. Results: The operation of 15 patients were successfully completed. The average operation time was 159.7min. The average blood loss during operation was 76ml. The average drainage volume of postoperative drainage tube was 170ml. The follow - up was 3 to 12 months. The imaging improvement rate was 100% Completely disappeared in 3 cases, water level reduced to grade Ⅰ in 10 cases, reduced to grade Ⅱ in 2 cases. Two patients developed asymptomatic grade I ureter reflux without special treatment. Conclusion: The modified insert nipple laparoscopic ureteroscopic bladder replantation is a safe, reliable and simple and effective surgical method.