后腹腔镜下离断式肾盂输尿管成形术治疗婴幼儿肾盂输尿管连接部梗阻

Retroperitoneal laparoscopie dismembered pyeloplasty for ureteropelvic junction obstruction in infants

目的探讨后腹腔镜离断式肾盂输尿管成形术在婴幼儿肾盂输尿管连接部梗阻中的临床应用价值。方法对收治并实施后腹腔镜离断式肾盂输尿管成形术的15例年龄4～24月的婴幼儿患者(后腹腔镜组)进行回顾性分析,以同期相同术者完成的传统经腹腹腔镜9例(经腹腹腔镜组)及经腰部小切口开放手术13例2岁以下婴幼儿(开放手术组)肾盂输尿管成形术做对照。结果手术时间89～205 min,平均(121.88±19.09)min,与经腹腹腔镜组对比差异无统计学意义(P=0.499),但长于开放手术组;术中出血2～10 mL,平均(3.75±1.59)mL,3种术式间对比差异无统计学意义(P>0.05),无意外损伤;后腹腔镜组及开放手术组术后恢复进食时间更快,差异有统计学意义(P<0.05),经腹腹腔镜组1例患者因尿液外渗腹膜炎再次手术;术后随访6个月至4年彩超提示肾积水均明显缓解,治疗前后对比差异有统计学意义(P=0.000),随访行泌尿系造影分肾功能评价正常。结论婴幼儿后腹腔镜离断式肾盂输尿管成形术手术安全,创伤小、恢复快、美容效果好、对腹腔的干扰小、操作空间足够、值得推广。

Objective To assess the clinical application of retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction(UPJO) in infants. Methods Retroperitoneoscopic dismembered pyeloplasty was performed on 16 patients with infantile UPJO from January 2014 to June 2017. The infants with UPJO received traditional abdominal laparoscopic or open surgery with small incision during the same period were selected as controls. Results The operations were successful in 15 cases. Their hydronephrosis were significantly improved during the 6 months to 4 years follow-up(P=0.000 009). Compared with traditional abdominal laparoscopic surgery, the dismembered pyeloplasty, There were no significant difference in the operation time between the dismembered pyeloplasty and traditional abdominal laparoscopic surgery [(121.88±19.09)min vs.(128.89±11.88)min, P=0.499], nor in intraoperative blood loss [(3.75±1.59)mL vs.(4.55±1.95)mL, P=0.475].Conclusion Retroperitoneoscopic dismembered pyeloplasty for UPJO in infants is a mini-invasive, safe, with good cosmetic effect and small disturbance to the abdominal cavity, and effective procedures.