经腹腔途径和经后腹腔途径腹腔镜下肾盂成形术治疗UPJO的临床疗效比较

Clinical effect of transperitoneal and retroperitoneal laparoscopic pyeloplasty on the treatment of ureteropelvic junction obstruction

目的:比较经腹腔途径和经后腹腔途径腹腔镜下肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床疗效。方法:选取2012年4月~2017年3月我院收治的86例UPJO患者,根据入院的时间顺序应用随机数字表法分为观察组和对照组,每组43例。对照组为经腹腔途径腹腔镜下肾盂成形术(TPLP),观察组为经后腹腔途径腹腔镜下肾盂成形术(RPLP)。比较两组患者术中、术后情况及并发症。结果:两组患者手术时间、出血量比较差异无统计学意义(P>0.05),观察组的裁剪缝合时间、手术切口长度显著长于对照组(P<0.05)。观察组的肛门排气时间、引流管留置时间、下床活动时间显著短于对照组(P<0.05),两组患者术后视觉模拟评分(VAS)、术后住院时间比较差异无统计学意义(P>0.05)。两组患者高碳酸血症、皮下水肿、尿漏、继发性腹膜炎并发症发生率比较差异无统计学意义(P>0.05)。结论:尽管TPLP治疗UPJO的裁剪缝合时间、手术切口长度显著短于经后腹腔途径,但从有效性而言,经后腹腔途径肛门排气时间、引流管留置时间、下床活动时间显著短于经腹腔途径,并且2种途径的并发症比较无显著差异,因此RPLP治疗UPJO值得推广。

Objective:To compare the clinical efficacy between transperitoneal and retroperitoneal laparoscopic pyeloplasty on the treatment of ureteropelvic junction obstruction(UPJO).Method:From April 2012 to March 2017,86 cases of UPJO were admitted in our hospital.According to the admission sequence and using random number table,they were divided into observation group and control group,43 cases in each group.The control group was treated by transperitoneal laparoscopic pyeloplasty(TPLP).The observation group was treated by retroperitoneal laparoscopic pyeloplasty(RPLP).Intraoperative,postoperative data and complications were compared between the two groups.Result:There was no significant difference in operative time or bleeding between the two groups(P>0.05).The cutting and suture length and incision length of the observation group were significantly longer than those of the control group(P<0.05).The drainage tube indwelling time was significantly shorter and anal exhaust time and ambulation time was significantly earlier in the observation group than those in the control group(P<0.05).There was no significant difference in postoperative VAS pain score or postoperative hospital stay between the two groups(P>0.05).Also,there was no significant difference in the incidence of complications of hypercapnia,subcutaneous edema,urine leakage or secondary peritonitis between the two groups(P>0.05).Conclusion:Although TPLP can shorten the time of incision and suture and the length of incision is significantly shorter than that of retroperitoneal approach,patients undergoing RPLP experienced shorter drainage tube indwelling time and earlier anus exhaust and ambulation time.However,there was no significant difference in complications between the two approaches.Thus,RPLP deserves to be popularized in the treatment of UPJO.