经腹入路腹腔镜肾盂成形术治疗儿童肾盂输尿管连接部梗阻

Study on the transabdominal nephropyeloplasty by laparoscopy for pediatric UPJO

目的探讨经腹腔入路腹腔镜肾盂成形术治疗儿童肾盂输尿管连接部梗阻（UPJO）的可行性、安全性及初步经验。方法本组9例患儿，共10侧手术，为2011年6月至2014年5月收治的1岁5个月至14岁以内肾积水儿童。年龄1岁5个月至14岁，平均年龄8岁。男性8例，女性1例。左侧7例，右侧3例。有腰痛症状8例，无症状2例（胎儿期 B 超检查发现肾积水）。其中肾重度积水5例，中度积水4例，轻度积水1例。先后行双侧肾盂成形术1例。输尿管狭窄扩张及置内支架管失败2例。所有患儿经 IVU 或 CTU 或 MRU 检查，确诊为 UPJO。均采用经腹腔入路腹腔镜离断式肾盂成形术。结果9例10侧患儿手术均获成功，无中转开腹手术或另外增加鞘管，无术中并发症。手术时间150～522 min，平均344.2 min。出血量10～100 mL，平均45 mL。术后肠道功能恢复时间1～3 d，平均2.1 d。术后住院7～10 d，平均8.5 d。术后采用超声，MRU 或 CT 三维重建、ECT 随访6～36个月，均显示肾实质有不同程度增厚，肾积水均明显减轻或消失，吻合口处较宽敞，术后无吻合口狭窄、尿漏及腹内脏器损伤等并发症。肾功能明显改善，患儿自觉症状消失。结论经腹腔入路腹腔镜肾盂输尿管成形术治疗儿童 UPJO 肾积水安全可行，效果良好，并发症少，对肠道干扰不大，美容效果良好，值得推广。选择手术病例应遵循由易到难过渡的原则。

Objective To discuss the safety,feasibility,preliminary empirical analysis of transabdomi-nal nephropyeloplasty by Laparoscopy for pediatric Uretero Pelvic Junction Obstruction （UPJO）. Method-s There were 1 female patient and 8 male patients with hydronephrosis （6 left and 2 right and 1 both side）, aged from one year and five months to 14 years old,average age 8 years,8 cases with waist-ache,2 symptom-less cases.There are 5 cases with severe hydronephrosis,4 cases with moderate hydronephrosis,and 1 case with mild hydronephrosis.Two cases were failed to implant internal ureteral stent and dilate ureteral stricture. All cases have been diagnosed with UPJO by IVU,CTU and MRU,and treated by surgical transabdominal py-eloplasty by laparoscopy. Results All cases successfully underwent laparoscopic transabdominal pyeloplasty, no conversion to open surgery or additional trocar,no intraoperative complications.The time of operation was 150 -522 minutes （mean time of operation was 344.2 min）;and blood loss was 10 -100 mL（mean blood loss was 45mL）;intestinal postoperative recovery time was 1 -3 days （mean recovery time was 2.1 days）;the postoperative hospital stay was 7 -10 days （mean hospital stay was 8.5 days ）;all patients were followed up for 6 -36 months with ultrasound,ECT、MRU and spiral CT scanning and three dimensional （3D ）recon-struction technique.The check result showed the thickness of renal parenchyma increased,and hydronephrosis were relieved or disappeared,and there was no postoperative anastomotic stenosis,urinaryfistula and injury of abdominal organs.All patients ＇renal function improved significantly,and rational symptom was disappeared. Conclusion Laparoscopic transabdominal pyeloplasty in the treatment of pediatric UPJO is safe and feasible, and there are less complications,intestinal disturbancesis and better cosmetic effect by this kind of procedure. 〈br〉 It is worthy of application in large scale,but surgeons should follow the principles from the easier to the more advanced.