后腹腔镜治疗输尿管腔外良性压迫所致肾盂输尿管连接部梗阻

Retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty for the treatment of UPJ obstruction due to benign oppression

目的探讨后腹腔镜治疗输尿管腔外良性病变压迫所致肾盂输尿管连接部梗阻的优势。方法21例良性病变压迫所致肾盂输尿管连接部梗阻患者,其中纤维索带压迫7例,异位血管压迫11例,腔静脉后输尿管压迫3例。术前均经B超,静脉肾盂造影(IVP),16层螺旋CT尿路造影(CTU)确诊后采用后腹腔镜下解除肾盂输尿管连接部外在压迫,行肾盂成形术。结果手术均顺利且证实术前诊断,手术时间1-3 h,平均94 min;出血量50-120 mL,平均95 mL;术后住院时间5-7 d,平均5.6 d。术后随访3个月到1年,肾脏、输尿管积水明显好转。结论CTU对良性病变压迫所致肾盂输尿管连接部梗阻的定位及定性诊断具有特殊价值。后腹腔镜下解除压迫,行肾盂成形术具有损伤小、术后恢复快和住院时间短等优点,有良好的临床应用前景。

Objective To evaluate the technique of retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty for the treatment of ureteropelvic junction （UPJ） obstruction due to benign oppression. Methods 21 cases which were diagnosed UPJ obstruction due to benign oppression, including fiber chords in 7 cases, cross vessels in 11 and postcaval ureter in 3 by ultrasound B, IVP and CTU, underwent laparoscopic Anderson-Hynes dismembered pyeloplasty via postabdominal cavity approach. Results All the operations were accomplished uneventfully. The operation time was 1-3 hours （mean, 94 min）, and the estimated intraoperative blood loss, 50-120 mL （mean, 95 mL）. The postoperative hospital stay was 5-7 d （mean, 5.6 d）. 3 to 12 months after the procedure, hydronephrosis, which were investigated by Ultrasound B and IVP, were significantly improved. Conclusion CTU examination is a good alternative for patients. Retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty is safe and efficient for the treatment of UPJ obstruction due to benign oppression. It is a promising technigue in clinical practice.