迷你腹腔镜和传统腹腔镜术治疗肾孟输尿管连接部狭窄的临床对照研究

Comparative study between mini-laparoscopic and conventional laparoscopic instruments for treatment of ureteropelvic junction obstruction

目的：探讨使用迷你腹腔镜经后腹腔肾盂成形术治疗肾盂输尿管连接部狭窄（UPJO）的安全性和临床治疗效果。方法：2011年9月-2014年9月应用迷你腹腔镜术治疗UPJO患者29例（MLP组）,同期应用目前标准腹腔镜手术治疗该病患者22例（SLP组）,并对两组的临床治疗结果作对比分析。结果：两组患者的肾盂输尿管成形术均成功完成,均无中转开放手术患者。两组在手术时间、手术出血量、留置引流管时间、术后恢复饮食时间、尿瘘及伤口感染发生率等方面差异无统计学意义（P〉0.05）。MLP组患者平均住院时间、术后额外止痛药需求量、术后当天疼痛评分均小于SLP组（P〈0.05）。术后随访平均时间23（6-36）个月。术后1年时,平均肾集合系统扩张分离的前后径值与术前相比,两组均明显减少,但两组间差异无统计学意义（P〉0.05）;利尿肾图显示患侧肾平均GFR两组差异无统计学意义[MLP组（45±18）ml/min vs SLP组（47±16）ml/min,P〉0.05],但与术前相比,两组GFR值均明显增加。患者形体恢复满意度调查,MLP组的＂很满意＂明显大于SLP组（P〈0.05）。结论：迷你腹腔镜进行肾盂成形术治疗UPJO安全可靠,能取得和传统腹腔镜术同样的临床治疗效果,但手术创伤更小,术后形体恢复更满意。

Objective：To evaluate safety,clinical efficacy,and cosmetic results after pyeloplasty using minilaparoscopic instruments（MLP）compared with standard laparoscopic pyeloplasty（SLP）in patients with ureteropelvic junction obstruction（UPJO）.Method：From September 2011 to September 2014,29 extroperitoneal MLPs were performed,while 22 extroperitoneal SLPs were conducted in patients with UPJO in our hospitals.The data of two groups were reviewed and studied.Result：Operations of two groups were successful without conversion to open surgery.There was no difference in operative duration,blood loss,duration of indwelling catheter,time for starting normal diet,or perioperative complications between two groups（P〉0.05）.However,the average postoperative hospital stay,postoperative analgesics required and the pain numerical rating scale（NRS）at first postoperative day were less or lower in group MLP than that in group SLP（P〈0.05）.Mean follow-up time was 23（range,6-36）months.The value of anteroposterior pelvic diameter on ultrasound within each group decreased significantly（P〈0.05）,but were similar between the two groups one year after surgery（P〉0.05）.The GRFs of impaired split renal function in both groups significantly elevated,whereas there was no significant difference in mean value of GRF between the two groups one year postoperatively[MLP：（45±18）ml/min vs SLP：（47±16）ml/min,P〉0.05].The questionnaires showed that patients in group MLP were significantly more satisfied with their cosmetic result.Conclusion：Our initial experience may suggest that pyeloplasty using MLP instruments provide similar therapeutic effects but more minimal invasion and cosmetic satisfaction than pyeloplasty using SLP instruments.