腹腔镜下复杂性肾盂输尿管连接部梗阻术式途径选择

Technique and approach of laparoscopic pyeloplasty for complex ureteropelvic junction obstruction

目的探讨腹腔镜下复杂性肾盂输尿管连接部梗阻(UPJO)的术式途径。方法回顾性分析该院2000～2007年收治的48例复杂性UPJO患者腹腔镜下手术方式及途径,其中22例经腹腔途径行肾盂输尿管离断成型术,3例为输尿管镜下内切开术后的双侧UPJO患者,12例曾行开放性肾盂或输尿管切开取石术,7例为较肥胖者;26例为经后腹腔途径肾盂输尿管离断成型术中,17例曾行输尿管镜下内切开术,5例为血管压迫,4例为纤维条索压迫,均无同侧开放性手术史。术后留置单条或双条双J管,1～3个月更换,输尿管镜检观察肾盂输尿管吻合口愈合情况,必要时行镜体扩张或内切开术。结果42例1次治愈,更换双J管1～3次,6例经输尿管镜下扩张或内切开、更换双J管共3～6次治愈。肾积水明显减轻,IVU及输尿管镜检UPJ通畅。随访6个月～18个月,平均12个月,IVU及输尿管镜检无明显再狭窄。结论对于双侧、曾行开放或腔内手术、长段狭窄、较肥胖者、外部压迫等复杂性UPJO患者,腹腔镜下选择合适的径路,术后留置合适的双J管,定时更换,是复杂性UPJO患者微创治疗的较好选择。

[Objective] To evaluate the technique and approach of laparoseopie Anderson-Hynes pyeloplasty for complex ureteropelvic junction obstruction （UPJO）. [Methods] The technique and approach of laparoscopic Anderson-Hynes pyeloplasty for 48 eases with complex ureteropelvic junction obstruction were analyzed retrospectively. 22 eases underwent laparoseopic Anderson-Hynes pyeloplasty via abdominal cavity approach. Of the 22 cases, 3 cases got UPJO after transureteroseopic incision, 12 eases after open penis or ureter lithotomy, and 7 eases were of obesity. 26 cases underwent laparoseopie Anderson-Hynes pyeloplasty via retroperitoneal cavity approach. Of the 26 eases, there were 5 eases of vascular compression, 4 cases of fiber cord compression, and 17 eases who had UPJO after transureteroseopie incision. Single-or dual-double J tubes were placed in all the patients after operation, and were replaced in 1-3 months. [Results] The operation was successful in all the cases. 42 cases were cured at a sin- gle stage and double J tubes were replaced 1-3 times. 6 eases were cured by transureteroseopic expansion or incision and double J tubes were replaced in 3-6 times. During the follow up of 6 to 18 months（mean 12 months）, there was no ureteric stricture. [Conclusions] Minimally invasive treatment for complex ureteropelvie junction obstruction is a pretty good choice by appropriate approach of laparoseopie pyeloplasty, regular replacement of indwelling double J tubes after operation.