后腹腔镜离断式肾盂成形术36例报告

Retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty(a report of 36 cases)

目的探讨后腹腔镜下离断式肾盂成形术的临床价值。方法2003年5月～2007年10月后腹腔镜下对36例肾盂输尿管连接部狭窄患者行离断式肾盂成形术。腰部常规取3处穿刺孔,显露肾盂、输尿管移行部,切除病变段输尿管,裁剪扩张肾盂,缝合成形肾盂输尿管移行部。结果36例手术操作成功完成,手术时间110～240min,平均140min,术中出血量30～120mL,平均60mL,术后住院8～20d,平均11d,术后并发皮下气肿9例、漏尿3例,1例穿刺孔脂肪液化。32例获随访1年,术后3个月均行IVP检查,31例肾积水程度与术前比较明显缓解或恢复正常,证实肾盂输尿管吻合口通畅。1例肾积水程度变化不明显,继续观察3个月后出现肾区胀感,给予输尿管镜检扩张后症状消失。结论后腹腔镜离断式肾盂成形术疗效确切、微创,随着腹腔镜操作技艺的熟练,必将取代传统开放手术。

[Objective] To evaluate the clinical value of laparoscopic Anderson-Hynes dismembered pyeloplasty. [Methods] A total of 3h patients underwent laparoscopic Anderson-Hynes dismembered pyeloplasty from May 2003 to October 2007. The operation was performed through 3 lumbar ports. The ureteropelvic junction was exposed and ureteropelvic junction obstruction was resected and enlarged renal pelvis was sheared, then pyeloplasty was performed. [ Results ] The operation was successful in all 36 cases. The operation time was 110-240 minutes with a mean of 140 minutes. The blood loss was 30-120 mL with a mean of 60 mL. The postoperative hospitalization was 8-20 days with a mean of 11 days. There were some complications such as pneumoderma in 9 cases, leakage of urine in 3 cases, fat liquefaction in 1 case. Thirty-two cases were followed up and IVP was performed in 3 month after operation. In 31 cases, hydronephrosis was remitted which confirmed that anastomosis orifice of pelvis and ureter was smooth. In another case, hydronephrosis was stable, and the feeling of expansion in renal region disappeared after distention of ureter. [Conclusions] Retroperitoneal laparoseopic Anderson-Hynes dismembered pyeloplasty has advantages of good effects, minimal invasion and safety. With the development of laparoseopie technique, it will certainly displace the traditional open operation.