后腹腔镜下Hellstrom术治疗异位血管导致的肾盂输尿管连接处狭窄

Retroperitoneal laparoscopic Hellstrom technique： A management of ureteropelvic junction obstruction duetocrossingvessel

目的总结后腹腔镜下Hellstrom术将肾下极异位血管游离后包埋固定在宽大肾盂表面,治疗因异位血管导致的肾盂输尿管连接处狭窄（UPJO）的方法。方法39例患者术前常规行IVU、逆行造影、B超或磁共振尿路成像（MRU）,确诊为UPJO。术中发现17例异位血管压迫导致原发性UPJO,严格筛选后对其中8例施行Hellstrom术。术后1个月行B超、IVU及肾功能检查,此后每3个月行相同检查。手术成功标准是症状（疼痛、感染等）缓解或消失,B超及IVU检查肾积水缓解或消失,肾功能改善。结果无中转开放手术。平均手术时间45（40～60）min,术中出血少,可忽略不计。8例异位血管中6例为背侧,2例为腹侧。术后平均住院时间5（4～7）d。术后均未使用止痛剂。术后平均随访13．6（12～15）个月,8例均达到手术成功标准,未见漏尿、切口感染等并发症。结论后腹腔镜下可以对异位血管（尤其是背侧血管）和输尿管很好地辨认及操作,而且在Hellstrom术中不破坏肾脏集合系统的完整性,因此在严格筛选病例的情况下,后腹腔镜下Hellstrom术是治疗异位血管导致UPJO的较好方法。

Objective To report the retroperitoneal laparoscopic Hellstrom technique in treat ment of ureteropelvic junction obstruction（UPJO） caused by crossing low pole vessel. Methods Thirty-nlne cases were diagnosed as UPJO by ultrasound, IVP, retrograde pyelography or MRU be fore operations. When retroperitoneal laparoscopic operations were resorted, 17 cases of UPJO caused by crossing vessels were found. Hellstrom technique was performed to 8 cases. IVP, renal ultrasound and renal function examination were followed up at I month postoperatively and every 3 months there- after. Success was considered as relief of the symptoms such as pain, infection, and IVP improve ments（less hydronephrosis, visible UPJ and normal drainage）, and improvement of renal function by renal function examination. Results There was no conversion to open surgery during operations. The mean operative time was 45 min （40-60 min）. Blood loss was negligible. Crossing vessels were identified to be anterior in 2 cases and posterior in 6 cases to renal pelvis. Postoperative hospital stay was 5 d （range 4-7 d）. The collecting systems were intact without double J stent in all cases. The mean follow-up was 13.6 months （12- 15 months）. In all patients, the obstructions were resolved or significantly improved, and no complications such as urine leakage and infections were found. Conclusions Some cases of UPJO associated with crossing vessel seem to be suitable to retroperitoneal laparoscopic Hellstrom technique. Retroperitoneal laparoscopy as a minimally invasive approach may offer a good opportunity to resolve the problem of crossing vessels in UPJO.