输尿管支架管和肾盂引流管在腹腔镜肾盂成形术中的应用

Application of indwelling renal pelvis drainage and ureteral stent in laparoscopic pyeloplasty

目的探讨腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻，术中同时放置输尿管支架管和肾盂引流管引流的可行性及其效果。方法2011年8月至2012年10月首都儿科研究所收治的肾盂输尿管连接部梗阻引起的儿童肾盂积水18例，男14例，女4例；平均年龄66个月（3—182个月），行腹腔镜离断式肾盂成形术，术中同时放置输尿管支架管和肾盂引流管，术后7d拔除输尿管支架管，9d拔除肾造瘘管。结果18例患儿均手术成功，无中转开腹，手术时间90～150min，平均102．8min。1例输尿管支架管于术后第3天自行脱出，1例因。肾盂造瘘管血块堵塞于术后第3天拔出输尿管支架管，无尿瘘及吻合口狭窄。随访6个月，复查彩超肾盂积水消失13例，5例明显改善。结论腹腔镜肾盂成形术中同时放置输尿管支架管和肾盂造瘘管，引流可靠，值得推广；且避免再次麻醉取管和长期留置支架管引起的并发症，提高了患者的生活质量。

Objective To assess the feasibility and efficacy of renal pelvis drainage and ureteral stent of lapa- roscopic pyeloplasty in treatment of ureteropelvic junction obstruction. Methods Eighteen patients （ 14 boys and 4 girls） with ureteropelvic junction obstruction,the average patient age was 66 months （range 3 - 182 months）, who un- derwent transabdominal laparoscopic Anderson-Hynes pyeloplasty in Capital Institute of Pediatrics from Aug. 2011 to Oct. 2012 were selected. The ureteral stent and renal pelvis drainage were installed during the performance of surgery. They were removed in 7 days and 9 days after operation respectively. Results Eighteen cases successfully underwent laparoscopic pyeloplasty ,without conversion to open surgery. The mean operating time was 102.8 minutes （ranging be- tween 90 and 150 minutes）. Two cases had complications on postoperative day 3, one patients ureteral stent was inad- ver-tentely pulled out, another was removed because of blood clots. No patient had postoperative urinary leakage or anas- tomotic stenosis. Postoperative follow-up time was 6 months. The hydronephrosis vanished in 13 patients, reduced obvious ly in 5 patients as revealed by ultrasound examination. Conclusions Intraoperatively, renal pelvis drainage and ureteral stent for postoperative drainage is effective, and it is worthy of application in a large scale. Patients can avoid further anesthesia for removing stents and the complications of long-term indwelling stent tubes, and have an improved quality of life.