腹腔镜手术治疗肾盂输尿管连接部狭窄19例

Laparoscopic treatment of ureteropelvic junction obstruction

目的 评价腹腔镜手术治疗肾盂输尿管连接部狭窄（ureteropelvic junctiono bstruction，UPJO）的疗效。方法 采用经腹路径对19例UPJO行离断式。肾盂输尿管成形术。打开侧腹膜，以。肾下极为标志游离出。肾盂输尿管连接部，切除狭窄部分，端端吻合肾盂输尿管并留置双J管。结果 19例手术全部成功，手术时间110～240min，平均150min。术中出血量50～100ml，平均80ml，无严重并发症发生。术后住院6～10d，平均7．8d。19例随访3～15个月，平均6个月，14例静脉尿路造影（intrarenous urography，IVU）无吻合口狭窄。结论 腹腔镜下离断式肾盂输尿管成形术治疗UPJO有效、可行，可以替代开放手术。

Objective To evaluate the clinical efficiency of laparoscopic operation for the treatment of ureteropelvic junction obstruction （UPJO）. Methods A total of 19 patients with UPJO underwent laparoscopic dismembered pyeloplasty. The operation was performed under general anesthesia. The patients were maintained in a lateral decubitus on unaffected side. After the establishment of pneumoperitoneum, 3～4 trocars were introduced at proper sites. During the operation, the lateral peritoneum was opened and the ureteropelvie junction obstruction was dissociated and dissected. The end - to - end anastomosis of the renal pelvis and ureter was conducted and a double -J stent was placed in the ureter. Results All the operations were performed successfully. The operation time was 110 ～240 min （mean, 150 min） , the blood loss was 50 ～100 ml （mean ,80 ml） , and the postoperative hospitalization time, 6 ～ 10 d （ mean, 7.8 d）. No severe complications occurred. Follow - up assessment with intravenous urography for 3 ～ 15 months （mean, 6 months） in 14 patients showed no ureteral stricture. Conclusions Laparoscopic dismembered pyeloplasty is an effective and safe procedure in the treatment of UPJO. It can replace the open surgery.