腹腔镜辅助技术在上尿路重建手术中的应用

Laparoscopic aid in upper urinary reconstructive operation

目的 探讨上尿路重建手术中应用腹腔镜辅助技术的方法及效果。方法 对78例上尿路梗阻患者（其中肾盂输尿管连接部梗阻58例，输尿管上段息肉5例，输尿管上段狭窄2例，输尿管上段结石13例），采用经腹腹腔镜下游离病变部位。然后经正对病变部位的套管针戳口，采用开放手术方式切除病变部位，行肾盂成形或输尿管端端吻合术。结果 78例手术均获成功。手术时间25～70min，平均41min；术中出血约15—30ml，平均约21ml。术中术后无并发症。7l例获随访6—26个月，平均10．5个月。腰部胀痛消失，IVP检查吻合口均无梗阻，B超提示患肾积水减轻。结论在上尿路重建手术中采用腹腔镜辅助技术与开放手术相结合的方式避免了困难的腹腔镜操作，并不明显增加腹壁创伤，却可以明显缩短手术时间，保证吻合质量，值得临床推广应用。

Objective To evaluate the efficacy and feasibility of laparoscopic aid in upper urinary reconstructive operation. Methods Fifty-eight patients with ureteropelvic junction obstruction, 5 patients with upper ureter polypus, 2 patients with upper ureter stenosis, and 13 patients with upper ureter lithiasis underwent upper urinary reconstructive operation with laparoscopic aid described as follows ： an incision 1 cm long was made, a 10 mm trocar and a 30° laparoscope were wt in, the part with lesion was isolated and resected, and then pyeloplasty or end-to-end anastomosis of ureter was performed. Results The mean operative time was 33 minutes （25 -45 minutes）. The mean blood loss was 20 ml （15 -25 ml）. Complications such as urinary leakage and infection were observed. The double J stent was removed at 1 month after the operation. Follow-up for 3 to 15 months in 20 cases showed alleviation of hydronephrosis. Conclusion An effective and safe method with less wound and operative time, combination of laparoscopic aid and open surgery in upper urinary reconstructive operation helps avoid difficult laparoscopic operation, does not increase trauma of the abdominal wall, and is worth promoting clinically.