肾盂输尿管连接处狭窄的微创治疗探讨

Mini-invasive treatment of ureteropelvic junction obstruction

目的探讨微创治疗肾盂输尿管交界处狭窄(UPJO)的适应证选择、手术技巧及临床应用价值。方法回顾性分析钬激光顺逆行腔内切开、后腹腔镜肾盂成形术治疗52例UPJO的临床资料。腔内逆行治疗组14例,顺行治疗组25例,后腹腔镜肾盂成形组13例。结果逆行腔内治疗组:手术时间30～60min,术后平均住院3d(2～6)d;临床治愈12例,2例治疗失败者再次给予钬激光内腔内切开,1例随访8个月显示治疗成功,1例随访4个月,目前临床症状改善。顺行腔内治疗组:手术时间60～90min,术后平均住院6(5～7)d;临床治愈21例,4例治疗失败者再次给予经皮肾微造瘘钬激光腔内切开,1例随访13个月显示治疗成功,3例分别随访4、6和9个月,目前临床症状改善。后腹腔镜治疗组:13例手术均获成功,手术时间120～200min,平均175min;出血量60～110mL,平均75mL。术后平均住院时间7.5d(5～8d)。围手术期无并发症。随访3～19个月,UPJ吻合口无狭窄,肾积水、肾功能均得到改善。结论只要适应证选择得当,微创治疗UPJO具有重要的临床价值。

【Objective】To investigate the choice of indication,surgical technique and the value of clinical application of mini-invasive treatment for ureteropelvic junction obstruction （UPJO）.【Methods】To retrospectively analyze clinical data of 52 cases of endopyelotomy using the holmium laser or retroperitoneoscopic dismembered An-derson-Hynes type pyeloplasty. There were 32 male patients and 20 female. Retrograde endopyelotomy for 14 patients,antegrade endopyelotomy 25 patients,retroperitoneoscopic pyeloplasty 13 patients. 【Results】Retrograde endopyelotomy group：The operation time ranged from 30 to 60 minutes,the mean postoperative hospital stay was 3 days （2～6 days）; clinical curing was 12 cases,and 2 failed cases had retrograde endopyelotomy again,1 case of them was followed up for 8 months and was cured,the other was followed up for 4 months and the clinical symptom was improved. Antegrade endopyelotomy group：the operation time ranged from 60 to 90 minutes,the mean postoperative hospital stay was 6 days （5～7 days）; clinical curing was 21 cases,4 failed cases had antegrade endopyelotomy again,1 case was followed up for 13 months and got cured,the other 3 cases were followed up for 4,6,9 months and the clinical symptom was improved. Retroperitoneoscopic pyeloplasty group：All cases underwent retroperitoneoscopic pyeloplasty successfully. The operation time ranged from 120 to 200 minutes （mean 175 minutes）,the blood loss ranged from 60 to 110 mL （mean 75 mL）,the mean postoperative hospital stay was 7.5 days. There were no intraoperative complications. During the follow-up period （3-19 months） there was no ureteric stricture,and the renal function and hydrocele had been improved.【Conclusions】There is important clinical value for Mini-invasive treatment of ureteropelvic junction obstruction,as long as the indication is appropriate.