腹腔镜下离断式肾盂瓣法肾盂成形术15例报告

Laparoscopic Dismembered Flap Pyeloplasty: a Report of 15 Cases

目的 探讨腹腔镜下离断式肾盂瓣法肾盂成形术治疗肾盂输尿管连接部长段狭窄或修剪狭窄段后吻合有张力的临床效果.方法 2005年1月-2010年5月对8例肾盂输尿管连接部长段狭窄和7例修剪狭窄段后吻合有张力者施行经腹腔途径离断式肾盂瓣法肾盂成形术,充分游离肾盂及狭窄段输尿管后,切除狭窄段输尿管,沿肾盂中部以上外侧缘做一切口,从上斜向下,至距肾实质1 cm,然后将肾盂的下半部分向下翻转形成肾盂瓣,与输尿管间断缝合,多余肾盂在距肾实质1 cm处切除,缝合.结果 15例手术均取得成功,手术时间80-145 min,平均92 min.术中出血量30-100 ml,平均53 ml.术后1-2 d拔除引流管.术后5-6 d拔除导尿管出院,无尿漏.术后4周拔除双J管.15例随访5-50个月,平均25个月,腰部疼痛等症状消失;B超提示肾盂积水明显改善,中度肾积水3例,轻度肾积水9例,无明显肾积水3例;IVU显示肾盂缩小,显影好转,其中12例在15 min内显影,3例显影略有延迟.结论腹腔镜下离断式肾盂瓣法肾盂成形术安全、可行.

Objective To study the clinical effect of laparoscopic dismembered flap pyeloplasty for long segment stricture of ureteropelvic junction obstruction （UPJO） or anastomotic tension following pyeloplasty. Methods From January 2005 to May 2010, laparoscopic dismembered pyeloplasty was performed on 8 cases of UPJO and 7 cases of anastomotic tension following pyeloplasty. All the procedures were performed with transperitoneal approach using three to four trocars. Firstly, kidney and pelvis of ureter were fully dissected, then the stricture of ureter was resected. After one incision on the lateral border of central pelvis above was made, the pelvis was reshaped to be a flap, then it was turned over and trimmed to be tubiform using 4-0 absorbable suture. Interrupted suture was performed to join pelvis flap to the ureter, then unnecessary pelvis tissue was resected at 1 cm from the renal parenchyma. Results All the 15 cases went through operations successfully. Mean operation time was 92 min （range, 80 - 145 min）. Mean intraoperative blood loss was 53 ml （range, 30 - 100 ml）. The drainage tube was removed on the first or second postoperative day. Patients were discharged on the 5th or 6th postoperative day with urinary drainage tube removed. No urine leakage occurred. The D-J tube was pulled out 3 to 4 weeks after surgery. During the 5 - 50 months＇ follow-up （mean, 25 months） in 15 eases, lower back pain disappeared. Uhrasonography revealed improvement of hydronephrosis, including 3 cases of moderate hydronephrosis, 9 cases of mild hydronephrosis and 3 cases of non-hydronephrosis. IVU showed the pevic shrinkage and improvement of development, including developing within 15 min in 12 cases and slightly retarded development in 3 cases. Conclusion Laparoscopic dismembered flap pyeloplasty is safe and feasible.