经皮腔内顺行球囊扩张结合内切开术治疗肾盂输尿管连接部梗阻

Treatment of ureteropelvic junction obstruction with percutaneous balloon dilatation combined with endopyelotomy

目的 观察经皮腔内顺行球囊扩张结合内切开术治疗肾盂输尿管连接部梗阻（UPJO）的疗效.方法 回顾分析2010年3月至201 2年9月我院采用经皮腔内顺行球囊扩张结合内切开术治疗肾盂输尿管连接部梗阻23例患者的病例资料并行随访.结果 患者23例,男性14例,女性9例;年龄21～71岁,平均（39±10.5）岁;左侧10例,右侧13例;原发性UPJO 18例（合并肾结石12例）,经皮肾镜碎石术后2例,肾盂输尿管连接部结石开放取石术后1例,开放肾盂成形术后1例,腹腔镜肾盂成形术后1例,狭窄段长度均不超过2 cm.所有患者均手术成功,围手术期无严重并发症发生.17例患者纳入随访,其中原发性UPJO患者12例,经皮肾穿刺取石术（PCN）术后患者2例,开放输尿管切开取石术后1例,腹腔镜下肾盂成形术后1例,开放肾盂成形术后1例,术后随访7～31月,未见复发.结论 经皮腔内顺行球囊扩张结合内切开术是治疗UPJO安全、有效的手术方式,具有微创、患者耐受度好、术后恢复快的特点,可有选择性地作为治疗UPJO的初始治疗手段.

Objective To evaluate the clinical efficacy of percutaneous balloon dilatation combined with endopyelotomy in the minimally invasive treatment of ureteropelvic junction obstruction （UPJO）. Methods Data of 23 cases of UPJO treated in our hospital with percutaneous balloon dilatation combined with endopyelotomy during Mar. 2010 and Sep. 2012 were retro- spectively reviewed. Results The patients included 14 males and 9 females, aged （39±10.5） years. There were 10 cases on the left side and 13 on the right side. 18 cases were primary UPJO, in which 12 were complicated with renal calculus. Two pa- tients underwent PCN, ] received ureterolithotomy, 1 pyeloplasty and 1 laparoscopic pyeloplasty. The length of stricture of all patients was less than 2 cm. All operations were performed successfully and no serious complication occurred. A total of 17 pa- tients were followed up for 7 to 31 months, among whom 12 were primary UPJO, 2 underwent PCN, 1 ureterolithotomy, 1 py- eloplasty and 1 laparoscopic pyeloplasty. All these patients obtained satisfactory therapeutic outcome. Conclusion Percutane- ous balloon dilatation combined with endopyelotomy is safe and effective for the treatment of UPJO, which can be selected as the initial treatment.