经皮顺行腔内切开术治疗肾盂输尿管连接部梗阻

Treatment of ureteropelvic junction obstruction with percutaneous endopyelotomy

目的:探讨应用经皮顺行腔内切开术(PAE)治疗肾盂输尿管连接部梗阻(UPJO)的适应症、疗效及技巧。方法:UPJO患者75例,其中肾盂输尿管连接部(UPJ)闭锁26例(34.7%)。男38例,女37例,平均年龄35(21～68)岁。左侧31例,右侧44例。原发性UPJO 39例(合并结石37例),开放UPJO成形术后8例,腹腔镜UPJO成形术后4例,开放手术取石术后14例,PCNL术后10例。均经B超、KUB、IVU、CT、逆行肾盂造影检查确诊。结果:Ⅰ期成功内切开69例(92.0%),4例(5.3%)间隔1周后Ⅱ期手术成功,2例放弃Ⅱ期治疗。单一应用PAE 59例(80.8%),PAE联合输尿管镜逆行内切开14例(19.2%)。术后3～6个月拔除输尿管支架管,随访6个月时,62例(84.9%)无复发,复发患者11例(15.1%)中包括UPJ闭锁患者10例。随访12个月时,55例(75.3%)无复发,24个月时52例(71.2%)无复发。21例复发患者中,9例行第二次PAE手术治愈,2例行第三次PAE手术后治愈,1例行开放肾盂成形术,9例每3～6个月更换双J管或动态观察。结论:PAE可以作为原发性UPJO的一线治疗。继发性UPJO或其他成形术后再狭窄的UPJO复发率高,但是PAE适用范围广,可重复性好,仍然是微创腔内治疗的有效手段。

Objective：To evaluate the clinical efficacy of percutaneous endopyelotomy （PAE） in the minimally t invasive treatmentof ureteropelvic junction obstruction （UPJO）. Method; Between June 200g and August 2010, 75 patients of UPJO had undergone PAE. Clinical data were analyzed retrospectively. Success was defined as both ra- diographic and symptomatic improvement, ltesult： Sixty-nine（92. 0%） patients were operated in one session of PAE, and 4 needed second session of PAE, 2 abandoned further treatment. Single PAE operations were per formed in 59（80.8%） patients. Combined antegrade and retrograde endopyelotomy were performed in 14（19.2~） patients. 65 patients were treated by electrocautery endopyelotomy, 5 by holmium laser, 3 by cold knife. The esti-- mated 6 months, 12 months, and 24 months recurrence-free survival rates for the endopyelotomy group were 84.9%, 75.3%, and 71.2%, respectively. Conclusion：PAE is effective for treatment of UPJO, while the recur- rence rate for secondary UPJO and those failed other treatment modality is high.