后腹腔镜辅助小切口离断式肾盂成形术治疗肾盂输尿管连接部梗阻

Retroperitoneal laparoscopy-assisted Anderson-Hynes dismembered pyeloplasty with small incision for the treatment of ureteropelvic junction obstruction

目的探讨后腹腔镜辅助小切口离断式肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床疗效.方法采用后腹腔镜辅助,小切口、放大镜下吻合的离断式肾盂成形术治疗UPJO患者12例.男8例,女4例.年龄5～48岁.B超及尿路造影显示UPJO伴有肾积水,其中B超提示重度肾积水4例,中度6例,轻度2例.IVU显影良好9例,显影差3例.结果12例手术均获成功.手术时间100～180 min,平均127 min;出血量30～100ml,平均70 ml;术后住院时间5～8 d,平均5.6 d;无手术并发症.术后随访3～12个月,经B超和IVU检查,UPJ吻合口无狭窄,肾积水减轻,肾功能有不同程度改善.结论后腹腔镜辅助小切口离断式肾盂成形术是治疗UPJO的较实用、微创的手术,值得临床选择应用.

Objective To describe the retroperitoneal laparoscopy-assisted Anderson-Hynes dismembered pyeloplasty with small incision for the treatment of ureteropelvie junction obstruction （UPJO） and to evaluate its clinical effect. Methods Twelve cases of UPJO （8 men and 4 women;age range, 5-48 years） underwent retroperitoneal laparoseopy-assisted, small incision, dismembered pyeloplasty. Of them,4 cases had severe hydronephrosis ;6,intermediate;and 2 ,mild by B-ultrasound and urography. Nine cases had good IVU imaging and 3 had poor IVU imaging. Results All the procedures were successful. The operative time was 100 - 180 rain （mean,127 min） ;the blood loss was 30 - 100 ml（mean,70 ml） and the postoperative hospitalization was 5 -8 d （mean,5.6 d）. No perioperative complication occurred. Follow-up of 3 - 12 months by intravenous urography and B-ultrasound showed no stricture at UPJ,and hydronephrosis was remitted and renal functions were improved. Conclusions Retroperitoneal laparoscopy-assisted Anderson-Hynes dismembered pyeloplasty with small incision is a feasible, minimally invasive and effective way to treat UPJO with less morbidity and shorter convalescence.