研究目的：迴腸輸尿管置換是一個開發成熟的手術，它給廣泛輸尿管缺損問題提供一個令人滿意的解決辦法。我們在豬的模型中想證明利用腹腔鏡技術來實行迴腸輸尿管置換以及合併反逆流措施的可行性。材料和方法：由經腹腔的方法，利用腹腔鏡擷取片斷的迴腸作爲左側整段輸尿管的代替物，迴腸的擷取與重建經是由肚臍套管切口的延伸傷口拉出體外施行，之後腎盂迴腸膀胱的吻合完全使用經腹腔鏡徒手縫合來完成八雙豬（平均體重28公觔）的研究。我們在以上所述的手術步驟都沒有使用任何的自動縫合裝置。手術前後的血清肌酸酐、電解質、動脈血氣體分析以及追蹤時取得腎盂攝影、膀胱攝影、病理檢查來評估手術的結果。結果：整個手術時間是6.5到11.5小時（平均8.2小時）。除了二雙以外，其他的手術後都能夠經由迴腸輸尿管達成尿液從腎臓引流到膀胱的目的。然而手術後有高比率的併發症，多數發生在腎盂迴腸的吻合處合併各種不同程度腎水腫，25%(2/8)有嚴重狹窄以及50%(4/8)顯示有輕微的狹窄。其他的併發症包括了50%(3/6)反逆流措施的部分脫落以及16.7%(1/6)完全的脫落。結論：這個研究透露，迴腸輸尿管的重建性腹腔鏡手術應用在像這樣平均體重28公觔豬雙的小動物上尚未開發成熟。發現有高失敗率(25%)以及高狹窄率(75%)的情形，需要進一步利用較大雙的動物研究來改進縫合的技巧，才能真正在臨床上運用腹腔鏡的方法來做迴腸的輸尿管取代手術。

OBJECTIVE: Ileal-ureteral substitution is a viable surgical procedure to provide a satisfactory solution to the problem of an extensive ureteric defect. We attest to the feasibility of a laparoscopic technique to perform a total ileal-ureteral substitution with and without an antireflux implantation procedure in a porcine model. MATERIALS AND METHODS: With the transperitoneal approach, laparoscopic harvesting of a segment of the ileum and extracorporeal reconstruction of the ileum as a total substitute for the ureter, followed by pyeloileal and ileovesical anastomoses with intracorporeal laparoscopic suturing were performed in 8 pigs (average weight 28 kg). Ileal-ureteral substitution with no antireflux implantation technique was performed as the control model in 2 pigs, and ileal-ureteral substitution with the ileal nipple method or intussusception method was performed in 3 pigs. We completed the above-mentioned procedures without using any automatic anastomosing device intracorporeally or extracorporeally. Perioperative serum creatinine, electrolytes, blood gas, and a follow-up excretory urogram, cystogram, and pathological examination were used to assess the surgical outcome. RESULTS: The total operative time was 6.5 to 11.5 (average, 8.2) hours. A patent ileal ureter from the kidney to the urinary bladder was found in all animals except 2. However, a high rate of postoperative complications occurred; most complications occurred at the pyeloileal anastomotic sites with various degrees of hydronephrosis: 25% (2/8) of cases showed severe narrowing and 50% (4/8) of cases showed mild stenosis. Other complications included partial or total dysfunction of the antireflux procedures in 50% (3/6) and 16.7% (1/6) of cases, respectively. CONCLUSIONS: This study showed that laparoscopic ileal ureter reconstruction is not yet viable in small animals like pigs with an average weight of 28 kg. High failure rates (25%) and stenotic rates (75%) were found. Further refinement of the suturing technique in studies using larger animals is required before the actual clinical application of laparoscopic total ileal ureter substitution can be realized.