后腹腔镜手术治疗肾盂输尿管连接部狭窄20例

Retroperitoneoscopic 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(UPJO)的疗效。方法采用腹膜外路径对20例UPJO行离断式肾盂输尿管成形术。打开肾周筋膜,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20例手术全部成功,手术时间100～160min,平均130min.术中出血量60～110ml,平均90ml,无严重并发症发生。术后住院7～12d,平均8d。20例随访3～15个月,平均6个月,超声示肾积水均不同程度好转,16例静脉肾盂造影(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 abstruction（UPJO）. Methods A total of 20 patients with UPJO underwent retroperitoneoscopic dismembered pyeloplasty. During the operation, the fascia renalis was opened and the reteropelvic 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 100 - 160 min（ mean 130 min）, the blood loss was 60 - 110 ml （mean 90 ml） ,and the postoperative hospitalization time 7 - 12 d（mean 8 d）. No severe complications occurred. Followup assessment with intravenous urography for 3 - 15 months（ mean 6 months） in 16 patients showed noureteral stricture. Conclusions Laparoscopic dismembered pyeloplasty is an effective and safe procedure in the treatment of UPJO. It can replace the open surgery.