经腹腔途径腹腔镜下离断性肾盂成形术的并发症分析

Analysis about the complications of transperitoneal laparoscopic dismembered pyeloureteroplasty

目的分析经腹腔途径腹腔镜下离断性肾盂成形术的术中及术后并发症发生情况。方法回顾性分析2011年11月至2015年12月收治的154例（162侧）肾盂输尿管连接处梗阻（UPJO）患儿的临床资料，男124例（80.7%），女30例（19.3%）。年龄8个月～15岁，平均3.9岁。病变位于左侧114例（74.0%），右侧32例（21.0%），双侧8例（5.0%）。28例（18.2%）术前有泌尿系感染、腰腹痛症状。154例（162侧）患儿均为初次手术，均由同一手术组行经腹腔途径腹腔镜下离断性肾盂成形术。总结分析术中及术后并发症发生情况。结果本组154例（162侧）中，2例中转开放手术。手术时间42～330 min，平均89 min。出血量2～50 ml，平均7.5 ml，无术中及术后输血病例。住院时间3～28 d，平均5.7 d。术后随访6～54个月，平均28个月。1例术后2个月拔除双J管后反复感染，术后6个月复查超声及静脉肾盂造影示梗阻较术前加重，再次行开放手术后治愈。总体手术成功率98%（151/154）。28例术前有症状患儿术后症状均消失。需要处理的术中并发症11例（7.1%），包括损伤迷走血管3例（1.9%），双J管置入困难需更换细管径双J管或改为外引流6例（3.8%），中转开腹2例（1.3%）；术后并发症24例（15.6%）：包括腹腔引流量多需延长引流管留置时间10例（6.5%），留置双J管期间感染需抗感染治疗7例（4.5%），拔除双J管后发热、腰痛、呕吐需对症治疗4例（2.6%），术后麻痹性肠梗阻、吻合口瘘及UPJO复发各1例（0.6%），分别采用保守治疗、再次开腹探查及二次手术治疗。结论经腹腔途径腹腔镜下离断性肾盂成形术是治疗UPJO安全、可靠的术式，并发症发生率低，手术成功率高。最常见的术中并发症是双J管置入困难，最常见的术后并发症是尿外渗。

Objective To summarize and analyze the intraoperative and postoperative complications arising from the Anderson-Hynes transperitoneal laparoscopic pyeloplasty （LP） procedure in the treatment of patients with ureteropelvie junction obstruction （UPJO）. Methods There were 154 consecutive patients who underwent transperitoneal LP between November 2011 and December 2015. These patients＂ data were retrospectively analyzed for intraoperative and postoperative complications. All the 154 patients were primary UPJO. Of the 154 patients, 124 （80.7%） were males and 30 （ 19.3% ） were females,114（74.0% ）were found in the left side,32（21.0% ）were found in the right side,while 8（5.0% ）were found in bilateral. The mean age was 3.9 years old（ ranged 8 - 180 months）. 28 patients（ 18.2% ） have the history of urological infection or flank pain. Results Mean operative time was 89 minutes （ ranged 42 - 330 rain）. The mean blood loss was 7.5ml （ranged 2 -50 ml）, and no blood transfusions were necessary intra- and post- operatively. The mean postoperative hospital stay was 5.7 days （ ranged 3 - 28 days）. The mean follow - up duration was 28 months （ranged 6 -54 months ）. 2 laparoseopic surgeries were converted into open surgeries. One patient suffered with repeated infection after removing the double J stent two months postoperatively. The ultrasound and intravenous urography showed the more severe obstruction compared to that before surgery. The second operation was performed and resolved this problem. The overall success rate was 98%. All 28 patients, who has preoperative symptoms, reported a complete resolution of symptoms after the procedure. Intraoperative complication occurred in 11 （7.1% ） patients, including injury of parapyelic vessel while in 3 （ 1.9% ） , the misplacement of the Double - J stent in 6 （3.8%） , conversion to laparotomy in 2（ 1.3% ）. The postoperative complications occurred in 24（ 15.6% ） patients, including urine leakage in 10（6.5% ） , infectious urinoma in 7 （4. 5% ） , infection after removing the Double - J in 4 （2.6%）, temporary intestinal obstruction, recurrent UPJO were in 1 （0. 6% ） respectively. Conclusions Our retrospective analysis confirmed that LP is an effective and safe procedure. The most common intraoperative complications are difficulty in double - J stent insertion. The most common postoperative complication is urine leakage.