经后腹腔单切口腹腔镜肾盂成形术2例报告

Single Incision Retroperitoneal Laparoscopic Pyeloplasty(Report of 2 Cases)

目的:探讨经后腹腔单切口腹腔镜技术行离断式肾盂成形手术的临床效果和技术方法。方法:采用单切口腹腔镜技术经后腹腔对2例确诊为肾盂输尿管连接部(UPJ)狭窄的患者实施离断式肾盂成形术(dismemberedanderson-hynes pyeloplasty),采用腰部腋中线切口,长约2.5 cm,置入自制的单切口Port,手术过程分别使用Cambridge endo可弯单通道腹腔镜器械、超声刀、普通持针器、普通腹腔镜器械等。结果:2例手术均获得成功,未中转开发手术,亦未增加皮肤切口,手术时间分别为230 min、160 min,术中出血60 ml、40 ml,术后住院时间均为6天,无围手术期并发症。术后6周拔除双J管并复查B超、IVU,肾积水明显减轻,吻合口无狭窄。结论:经后腹腔单切口腹腔镜肾盂成形术作为一种新兴技术治疗肾盂输尿管连接部狭窄是安全可行的,具有创伤更小、美容效果更好的特点。随着单孔腹腔镜器械以及腹腔镜技术的不断提高,这项技术值得在临床上推广应用。

Objective：To present our initial clinical experience of single incision, transretroperitoneal approach laparoscopic pyeloplasty. Methods：Two patients with uretropelvic j unction（UPJ） obstruction underwent transretroperitoneal single incision laparoscopic dismembered anderson hynes pyeloplasty, with waist axillary midline inei sion, about 2.5 cm, a single incision made for inserting port, Cambridge endo flexible laparoscopic instruments, ultrasonic knife, ordinary needle holder, and other common laparoscopic instruments were used during surgical procedures. Results：Both cases were technically successful, with no extra skin incisions, and there were no conversion to open procedure. The operative time were 230 mins and 160 mins,separately. The estimated blood loss were 60 ml and 40 ml,separately. The postoperative hospital stay both were 6 days. There were no perioperative complication occurred. Ultrasound B and Radiographic assessment by intravenous urography 2 months after the proce dures showed good outcome. Conclusions： Transretroperitoneal single incision pyeloplasty is technically feasible and safe to treat UPJ obstruction while providing a minimally invasive and superior cosmesis procedure. The technolo gy is worth further clinical application.