后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻的研究

Clinical Value of Retroperitoneal Pyeloplasty for Treatment of Ureteropelvic Junction Obstruction

目的探讨后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻（UPJO）的适应症、手术技巧及应用价值。方法回顾性分析经后腹腔镜治疗的38例UPJO患者的临床资料。其中男16例、女22例,年龄9-42岁。B超检查：肾盂轻度扩张积水（〈15mm）9例,中度（15-30mm）23例,重度（〉30mm）6例。合并肾盂结石3例。分别采用FoleyY-V成形术、Fenger成形术、Hellstr m术以及Anderson-Hynes成形术。结果38例手术均成功,无1例改开放手术。围手术期无并发症。术后随访6-36个月,患者症状消失,影像学显示肾盂输尿管连接部通畅,肾积水、肾功能均得到改善。结论后腹腔镜肾盂成形术是治疗UPJO有效、微创、安全、术后恢复快、住院时间短的一种手术方法,可望做为UPJO治疗的首选手术方法,值得临床推广。

Objective To explore the indications, surgical techniques and application value of petroperitoneal pyeloplasty for the treatment of ureteropelvic junction obstruction （UPJO）. Methods Clinical data of 38 cases patients with UPJO treated by the post -laparoscopic were retrospectively analysed. Among them,16 cases were male and 22 female,the patients age ranged from 9 to 42 years. B - uhrasonography showed hydronephresis 〈 15 mm（mild） in 9 cases, 15 - 30mm （moderate） in 23 cases, 〉 30mm （severe） in 6 cases, and 3 cases were complicated with pelvic stones. Foley Y - Vpyelo- plasty, Fenger pyeloplasty, Hellstrom technique, and Anderson - Hynes＇ s pyeloplasty were respectively adopted. Results The operation of 38 cases were successed, no patient was changed to open surgery. There were not intraoperative complications in perioperative time. The postoperative follow -up was 6 to 36 months. The symptom of patients disappeared. Imaging showed that ureteropelvic junction was unobstructed, hydronephrosis and renal function were improved. Conclusion Retroperitoneal pyelo- plasty is mini - invasive, reliable, safe, faster recover from operation, shorter hospitolized days for the treatment of UPJO. It may be used as the first choice of therapy for treatment of UPJO and extremely deserve the clinical expansion.