后腹腔镜辅助小切口离断肾盂成形术治疗肾盂输尿管连接部梗阻

Mini-Incision Dismembered Pyeloplasty Assisted by Retroperitoneal Laparoscopy in the Treatment of Adult Ureteropelvic Junction Obstruction

目的通过与常规后腹腔镜离断肾盂成形术的临床效果比较,评价后腹腔镜辅助小切口离断肾盂成形术治疗肾盂输尿管连接部(ureteropelvic junction,UPJ)梗阻的临床价值。方法回顾性分析2004年1月～2006年11月在我院行离断肾盂成形术成人患者47例临床资料,其中行后腹腔镜辅助小切口组(A组)22例(腋后线12肋下长4 cm小切口),后腹腔镜组(B组)25例。对2组手术时间、术中出血量、平均气道阻力、呼气末CO2分压、术后胃肠道功能恢复时间、引流管拔除时间、术后住院时间、尿漏发生率、术后肾积水缓解情况、肾小球滤过率改善情况进行统计分析。结果无一例术中并发症发生。与B组比较,A组手术时间短[(92.9±16.3)min vs(155.8±18.6)min,t=-12.251,P=0.000],术中出血量多[(18.9±6.3)ml vs(13.6±6.7)ml,t=2.782,P=0.008]但无临床意义,术中平均气道阻力小[(15.6±2.6)cm H2O vs(26.9±4.3)cm H2O,t=-10.715,P=0.000],呼气末CO2分压低[(36.0±6.9)cm H2O vs(51.6±6.7)cm H2O,t=-7.855,P=0.000]。2组术后胃肠道功能恢复时间、引流管拔除时间、术后住院时间、术后尿漏发生率和肾积水缓解情况差异无显著性。结论后腹腔镜辅助小切口离断肾盂成形术是治疗UPJ梗阻安全、有效、微创的治疗方法。

Objective To compare the efficacies of mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy and routine retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction （UPJ） obstruction. Methods The clinical data of 47 patients with UPJ obstruction, who underwent dismembered pyeloplasty from January 2004 to November 2006 in our hospital, were retrospectively analyzed. Of the patients, 22 were treated by mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy （ group A） , in whom a 4-cm incision was made under the costal margin at the posterior axillary line ; and the other 25 cases underwent retroperitoneal laparoscopic dismembered pyeloplasty （ group B）. The clinical data of the two groups, including the operation time, blood loss, average airway resistance and partial pressure of carbon dioxide, recovery of intestinal function, length of drainage and hospital stay, incidence of urinary leakage, and remission rate of hydronephrosis and improvement of GFR, were statistical analyzed by SPSS 13.0. Results No intra-operative complications occurred in either group. Compared with Group B, Group A had shorter operation time [（92.9±16.3） min vs （155.8±18.6） min, t= -12.251, P=0.000], more blood loss [（18.9±6.3） ml vs （13.6±6.7）ml, t =2.782, P=0.008], lower average airway resistance [（15.6±2.6） cm H2O vs （26.9±4.3） cm H2O, t= -10.715, P=0.000] and partial pressure of carbon dioxide [（36.0-＋6.9） cm H2O vs （51.6±6.7） cm H2O±6 t = -7. 855, P = 0. 000 ]. No statistical differences were detected in the recovery of intestinal function, postoperative length of drainage and hospital stay, incidence of urinary leakage, and remission rate of hydronephrosis and improvement of GFR. Conclusion Mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy is a safe, effective, and minimally invasive therapy for UPJ obstruction.