改良经腹腔镜肾盂成型术治疗肾盂输尿管连接处梗阻的疗效及安全性评价

Evaluation of efficacy and and safety of a modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty of pelviureteric junction obstruction

目的探讨改良经腹腔镜肾盂成型术治疗肾盂输尿管连接处梗阻(Ureteropelvic junction obstruction,UPJO)的疗效及安全性。方法选取2013年3月~2015年5月我院泌尿外科收治的UPJO患者62例为研究对象,按随机数字表法分为改良组与非改良组,每组各31例。改良组采用改良经腹腹腔镜术治疗,非改良组采用非改良术式治疗,观察并记录两组患者围手术期资料、并发症发生情况、随访结局及患者满意度等。结果 62例UPJO患者手术均成功,两组患者的手术时间、术中出血量、排气时间、并发症发生率无显著差异(P>0.05),非改良组止痛药用量较改良组大、住院天数较改良组长、术后手术口脂肪液化及感染几率较改良组高(P<0.05);术后1年,两组患者的肾集合系统扩展分离前后径(AP)均较术前明显降低、肾小球滤过率(glomerularfiltrationrate,GRF)较术前均明显升高(P<0.05)。结论改良经腹腔镜术治疗UPJO的疗效确切、安全性较好,创伤小、疼痛小、患者恢复时间短,优于非改良组非改良术式,可在临床推广应用。

Objective To access the efficacy and safety of modified retroperitoneal laparoscopic pyeloplasty of the treatment for ureteropelvic junction obstruction（UPJO）. Methods 62 patients with UPJO from March 2013 to May 2015 in our hospital were collected in department of urology, and divided into observation group and control group by the random number table method, 31 cases in each group. The observation group was treated with modified laparoscopic surgery, while the control group was treated with standard laparoscopic surgery. The perioperative period data, complications, patient satisfaction and follow-up outcomes of two groups were observed and compared. Results The UPJO operation was successful in 62 cases. There was no significant difference in operation time, blood loss, complication rate and ex- haust time between the two groups. The analgesic dosage in the non modified group was higher than that in the modified group. The number of days in hospital was better than that in the modified group. After 1 years, the AP of the two groups were significantly lower than those before the operation, and the glomerular filtration rate was significantly higher than that before operation （P〈0.05）. There is no difference between the two groups. Conclusion Modified transabdominal laparoscopic surgery for the treatment of UPJO is accurate, safe, less trauma, less pain and has short recovery time.