微创与开放术式治疗肾盂输尿管连接部梗阻的临床疗效对照研究

The comparison of clinical effect between the laparoscopic pyeloplasty and the open pyeloplasty in the treatment of the UPJO

目的探讨腹腔镜微创离断式肾盂成形术在肾盂输尿管连接部梗阻(UPJO)治疗中的价值。方法根据患者(或家属)意愿,将86例UPJO患者分为微创组和传统组各43例。微创组采用腹腔镜微创离断式肾盂成形术,传统组采用开放性肾盂成形术。比较两组手术时间、术中出血量、术后止痛药使用量、术后肠道功能恢复时间、术后住院时间、术后并发症发生情况、术后肾积水复发率等指标。结果微创组手术时间为(153.4±26.7)min,与传统组[(142.6±30.5)min]无统计学差异(P>0.05)。微创组术中出血量、术后止痛药使用量、肠道功能恢复时间、住院时间分别为(29.8±4.1)ml、(64.2±23.9)mg、(1.7±0.6)d、(7.3±2.5)d,均显著少于(或短于)传统组[(86.3±17.2)ml,(107.4±35.8)mg,(3.6±1.3)d,(13.5±4.2)d](P<0.05)。微创组并发症发生率和肾积水复发率均为2.33%(1/43),显著低于传统组[6.98%(3/43),16.28%(7/43)](P<0.05)。结论与开放性肾盂成形术比较,腹腔镜微创离断式肾盂成形术可以促进UPJO患者术后康复,降低并发症发生率和肾积水复发率,是目前治疗UPJO较为理想的方法,值得临床推广运用。

Objective To investigate the value of laparoscopic pyeloplasty in the treatment of UPJO.Methods Eighty-six patients with UPJO were divided into minimally invasive group and traditional group with 43 cases in each group,according to the patients（ or their families）willing.The minimally invasive group patients were treated by the laparoscopic pyeloplasty while the traditional group patients were treated by the open pyeloplasty.The operation time,bleeding volume and the amount of analgesic usage after operation,recovery time,hospitalization time,postoperative complications,postoperative recurrence rate of hydronephrosis of two groups were compared.Results The operation time of the minimally invasive group was（ 153.4 ± 26.7） min,with no difference compared with the traditional group[（ 142.6 ± 30.5） min]（ P 〉0.05）.The bleeding,analgesic usage,the time of intestinal function recovery and the hospitalization time were respectively（ 29.8 ± 4.1） ml,（ 64.2 ± 23.9）mg,（ 1.7 ± 0.6） d,（ 7.3 ± 2.5） d,which were significantly smaller（ or short） than those of the traditional group[（ 86.3 ± 17.2） ml,（ 107.4 ±35.8） mg,（ 3.6 ± 1.3） d,（ 13.5 ± 4.2） d]（ P〈 0.05）.The incidence rate of complication and recurrence rate of hydronephrosis in the minimally invasive group were all 2.33%（ 1 /43）,which were significantly lower than those of the traditional group[6.98%（ 3 /43）,16.28%（ 7 /43） ]（ P〈 0.05）.Conclusion Compared with the open pyeloplasty,the laparoscopic pyeloplasty can promote the rehabilitation and reduce the rate of complication rates and recurrence of hydronephrosis,which is worth of clinical application.