腹腔镜经腹腔与后腹腔途径治疗肾盂输尿管连接部梗阻的比较

Comparison of Laparoscopic Retroperitoneal and Peritoneal Approaches in the Treatment of Ureteropelvic Junction Obstruction

目的比较腹腔镜经腹腔与后腹腔途径治疗肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)的疗效。方法回顾性分析2011年6月~2015年5月98例UPJO的临床资料,其中腹腔组42例,后腹腔组56例,比较2组缝合时间、手术时间、中转开放手术、出血量、住院时间、并发症等方面情况。结果腹腔组缝合时间(57.6±3.6)min,明显短于后腹腔组(65.3±3.5)min(t=-10.647,P=0.000);腹腔组手术时间(139.7±10.6)min,明显短于后腹腔组(175.3±15.0)min(t=-13.113,P=0.000);腹腔组术后进食时间(3.7±0.8)d,明显长于后腹腔组(2.3±0.6)d(t=9.904,P=0.000)。腹腔组、后腹腔组术后住院时间分别为(8.8±2.6)、(9.2±2.7)d,无统计学差异(t=-0.737,P=0.463);术中出血量分别为(38.9±8.1)ml、(37.3±7.4)ml,无统计学差异(t=1.589,P=0.115);2组中转开放手术率分别为2.4%(1/42)、3.6%(2/56),无统计学差异(χ~2=0.000,P=1.000)。结论腹腔镜下肾盂成形术经腹腔途径缝合时间更快,手术时间更短,2种途径治疗UPJO均具有较高的成功率和较少的并发症,手术途径的选择应取决于医生的喜好、经验以及患者的病情。

Objective To compare the efficacy of laparoscopic retroperitoneal versus transperitoneal pyeloplasty for ureteropelvic junction obstruction（ UPJO）. Methods From June 2011 to May 2015,there were 98 patients with UPJO,including 42 patients who underwent transperitoneal laparoscopic pyeloplasty（ peritoneal group） and 56 patients who underwent retroperitoneal laparoscopic pyeloplasty（ retroperitoneal group）. The differences between the two groups in the intracorporeal suturion time,operation time,conversion rate,amount of bleeding,hospitalization time and complications were compared. Results The intracorporeal suturing time was shorter in the peritoneal group（ 57. 6 ± 3. 6） min than that in the retroperitoneal group [（ 65. 3 ± 3. 5） min,t =-10. 467,P = 0. 000]. The total operation time was shorter in the peritoneal group（ 139. 7 ± 10. 6） min than that in the retroperitoneal group [（ 175. 3 ± 15. 0） min,t =-13. 113,P = 0. 000]. But the postoperative feeding time was longer in the peritoneal group（ 3. 7 ± 0. 8） d than that in the retroperitoneal group [（ 2. 3 ± 0. 6） d,t = 9. 904,P = 0. 000]. The hospitalization time of the peritoneal group and retroperitoneal group was（ 8. 8 ± 2. 6） d and（ 9. 2 ± 2. 7） d,respectively,with no significant difference between the two groups（ t =-0. 737,P = 0. 463）. The amount of bleeding of the peritoneal group and retroperitoneal group was（ 38. 9 ± 8. 1） ml and（ 37. 3 ± 7. 4） ml,respectively,without significant difference（ t = 1. 589,P = 0. 115）. The conversion rates of the peritoneal group and retroperitoneal group were 2. 4%（ 1/42） and 3. 6%（ 2/56）,respectively,without significant difference（ χ^2= 0. 000,P = 1. 000）. Conclusion Transperitioneal laparoscopic pyeloplasty is associated with significantly shorter operation time and intracorporeal suturing time in comparison with retroperitoneal laparoscopic pyeloplasty. Both approaches have a high success rate and a low complication rate. The choice of approaches should depend on the doctor ＇s preferences,experience,and patient＇s conditions.