后腹腔镜离断式肾盂成形术的改良及应用效果

Clinical effects of modified retroperitoneoscopic dismembered pyeloplasty

目的：探讨后腹腔镜离断式肾盂成形术中输尿管吻合及双J管置人方法的改良及应用效果。方法：2010年6月～2013年1月，对32例肾盂输尿管连接部梗阻（ureteropelvicjunctionobstruction，UPJO）患者实施后腹腔镜离断式肾盂成形术，吻合方法采取两针固定连续缝合法，双J管放置采取Trocar外推置法。观察手术时间、吻合时间、置双J管时间、住院时间、并发症发生率、引流管放置时间等，总结手术技巧，并与前期18例采用间断缝合和双J管经Trocar内放置的后腹腔镜离断式肾盂成形术进行比较。结果：两组手术均获成功。改良手术组和对照组平均手术时间分别为（78．2±16．3）min、（114．7±17．5）min（P〈0．05），输尿管吻合时间分别为（24．2±4．9）min、（49．4±7．5）min（P〈0．05），双J管置入时间分别为（3．6±1．0）min、（9．1±2．2）min（P〈0．05），两组引流管放置时间、住院时间和并发症发生率比较差异无统计学意义（P〉O．05）。改良手术组随访3～30个月，平均9．2个月，B超提示肾积水消失11例，肾积水不同程度减轻21例。结论：后腹腔镜离断式肾盂成形术中采取两针固定连续缝合法吻合，可以降低输尿管吻合难度，缩短手术时间；经Trocar外推置法放入双J管，简便快速。

Objective： To evaluate clinical effects of the modified ureter anastomosis and double-J catheter in- sertion methods in retroperitoneoscopic dismembered pyeloplasty. Method： From June 2010 to January 2013, 32 patients （modified operation group） with ureteropelvic junction obstruction （UPJO） underwent retroperitoneo- scopic dismembered pyeloplasty by two-needle fixed running suture and double-J catheter insertion outside of tro car. The operating time, ureter anastomosis time, double-J catheter insertion time, hospital stay, incidence of complication, indwelling time of drainage were observed. These data were compared with the control group： 18 cases of retroperitoneoscopic dismembered pyeloplasty with ureter interrupted suture and double-J tube inserted in- side of trocar. Result： All operations were completed by retroperitoneoseopy without conversion to open surgery. The operating time of two groups were （78.2±16.3） minand （114.7±17.5） min respectively （P〈0.05）. Ure- ter anastomosis time of the two groups were （24.2±4.9） min and （49.4±7.5） rain respectively （P〈0.05）. Double-J catheter insertion time of the two groups were （3.6±1.0） min and （9.1 ±2.2） min respectively （P〈 0.05）. There was no significant difference in hospital stay, incidence of complication and indwelling time of drain- age between the two groups （P〉0. 05）. At a follow-up period of 3-30 months （average 9.2 months） B-ultra- sonography showed that hydronephrosis disappeared in 11 modified operation patients and alleviated a little in 21 patients. Conclusion： Two-needle fixed running suture make the ureter anastomosis easier and the operation time shorter in retroperitoneoscopic dismembered pyeloplasty. Double-J catheter insertion outside of trocar is easy to use and time-saving.