微创小切口离断式肾盂输尿管成形术231例

The small incision minimally invasive dismembered pyeloplasty

目的回顾性分析微创小切口离断式肾盂输尿管成形术治疗先天性肾盂输尿管连接部狭窄的可行性及手术效果。方法2009年12月至2013年6月，我们共收治先天性’肾盂输尿管连接部狭窄268例，其中231例采用微创小切口离断式。肾盂输尿管成形术。231例中，男152例，女79例；左侧156例，右侧58例，双侧17例。年龄6d至5岁11个月。诊断依靠超声、MR及ECT检查，部分病例选用静脉肾盂造影或cT检查。Grignon分级：Ⅲ级12例，Ⅳ级85例，V级134例。患儿均行Anderson—Hynes肾盂成形、肾盂输尿管吻合术。术后前半年每6～8周行超声和尿液检查，后半年每2～3个月复查1次，术后1年行静脉肾盂造影（we）和（或）核素肾图（ECT）检查。结果231例中，188例选用1．5～2cm切口顺利完成手术，27例延长切口至2—2．5cm，6例切口2．5～3cm，10例切口3—4cm。231例中，超声检查肾积水明显减轻者211例，积水无加重者19例，1例吻合口不通畅予再次手术。术后1年行IVP和（或）ECT检查，肾功能明显改善。结论对于婴幼儿及部分正常体重的学龄前儿童，微创小切口离断式肾盂输尿管成形术技术上是可行的，可以获得良好的手术效果。

Objetive To review retrospectively the feasibility and effects of small incision minimally invasive dismembered pyeloplasty for the treatment of congenital ureteropelvic junction obstruction. Methods From December 2009 to June 2013 ,GuangZhou Women and Childrens Medical Center（ ZhuJiang New Town ） received 268 patients with congenital ureteropelvic junction obstruction,and 231 of them were treated by small incision minimally invasive dismembered pyeloplasty. In the 231 patients, 152 were male, 79 were female, 156 were left side, 58 were right side, and 17 were both sides. The patients were between 6 days and 5 years 11 months old. The diagnosis was depended on ultrasound, MR, and ECT. Some were examined with IVP or CT. Grignon classification： 12 were level 3, 85 were level 4, 134 were level 5. All the patients were operated by Anderson - Hynes pyeloplasty. The patients were examined by ultrasound and took urinalysis every 6 ~ 8 weeks for the first six months and every 2 -3 months for the second six months after the operation, and examined by IVP or ECT 1 year after the operation. Results In the 231 cases, 188 received the operation successfully with incision between 1.5 ~ 2 cm, 27 need to extend the incision to 2 ~ 2.5 cm, and 6 cases to 2.5 ~ 3 cm, 10 ca- ses to 3 -4 cm. The 231 patient, in which 211 cases had obvious remission of hydronephrosis by ultrasound, 19 cases had no exacerbation, 1 cases needed to reoperation due to the obstruction of anastomotic stoma, were examined by IVP and ECT and the results showed that the function of kidney improved in all the cases. Conclusion The small incision minimally invasive dismembered pyeloplasty is technically viable for preschool child with normal weight, and the results are usually good.