后腹腔镜非离断成形术治疗肾盂输尿管连接处梗阻

The management of ureteropelvic junction obstruction by retroperitoneal laparoscopic nondismembered pyeloplasty

目的:评价3种后腹腔镜非离断成形术治疗肾盂输尿管连接处梗阻(UPJO)的临床疗效及其可行性。方法:对36例UPJO均有不同程度肾盂积水患者,分别使用FoleyY-V成形术、Fenger成形术及Hellstrm术行非离断成形术。结果:无一例改开放手术。在平均28个月的随访中,17例接受FoleyY-V成形术的患者中有2例复发,行开放离断成形术后解除梗阻;11例接受Fenger成形术的患者中1例复发,使用球囊扩张后治愈;8例接受Hellstrm术的患者均达到手术成功标准。结论:非离断成形术中保留异常狭窄段可能是导致术后有较高复发率的重要因素,因此在条件允许情况下应尽量选择离断成形术。对于Hellstrm术,在严格控制适应证的前提下,不失为一种治疗单纯因异位血管压迫而导致UPJO的较好手术方式。

Objective：To elucidate the clinical curative effects and feasibilities of the management of ureteropel vic junction obstruction by retroperitoneal laparoscopic nondismembered pyeloplasty. Methods： The clinical data of 36 cases of patients with UPJO were collected from 2002 to 2005. As nondismembered pyeloplasties, Foley Y V pyeloplasty, Fenger pyeloplasy and Hellstrom technique were resorted base on the judgements and filtrations during the operations. Followup studies included IVP, renal ultrasound and renal function examination after 4 to-6 weeks postoperatively when the double J tube was removed, and every 3 months thereafter range from 12 to 36 months （average 28 months）. Success was considered as amelioration of the symptoms such as pain, infection and so on, and IVP （less hydronephrosis, visible UPJ and normal drainage）, and improvement of renal function confirmed by renal function examination. Results：There was no conversion to open surgery. Among 17 Foley Y-V pyeloplasty receptors, there were 2 cases had recurrence during average 20 months after extraction of double J tube, and open dismembered pyeloplasy solved them thereafter. Among 11 Fenger pyeloplasty receptors, there was 1 case had recurrence during average 22 months follow up, and sacculus vestibularis dilation was resorted to treat it. The reasons of recurrences of these two nondismembered pyeloplasties should to be the reservation of anomaly ste nosis, and the ureter peristalsis was interfered by these procedures, this could be the main reason of recurrence. Among 8 Hellstrom technique receptors, the obstructions were resolved or significantly improved, and no complications such as urine leakage and infections were found during average 13.6 months follow up. The long term fol low-up should be imperative. Conclusions：Because the anomaly stenosis was reserved in some nondismembered py eloplasties, this could be the main reason of recurrence after operations. So the dismembered pyeloplasty should to be first considered if the conditions are suitable. Meanwhile, some special cases of UPJO associated with crossing vessel seem to be suitable to retroperitoneal laparoscopic Hellstrom technique.