腹膜后腹腔镜离断性肾盂成形术中改良裁剪技术的临床应用

Clinical effects of modified retroperitoneal laparoscopic dismembered pyeloplasty

目的:探讨腹膜后腹腔镜离断性肾盂成形术中采用改良裁剪技术治疗肾盂输尿管连接部梗阻(UPJO)的可行性、实用性、安全性。方法:2014年12月至2017年11月共完成11例腹膜后腹腔镜离断性肾盂成形术,采用“三点两段”法定位,于肾盂外侧最低点、输尿管外侧预计剖开的最低点预缝合,裁剪后将预缝合缝线打结完成第一针吻合后按常规完成肾盂输尿管成形。结果:本组11例手术均获成功,无一例中转开放手术。手术时间95~195 min,平均(125.6±5.2)min;术中出血量20~70 mL,平均(45.5±5.3)mL。无周围脏器损伤及严重并发症发生。术后住院6~9 d,平均(6.5±1.2)d。术后随访3~23个月,B超提示肾积水消失6例,5例肾盂积水较术前减少7~20 mm;其中7例复查静脉尿路造影,无吻合口狭窄发生。结论:腹膜后腹腔镜离断性肾盂成形术改良裁剪技术设计简单、易学,可降低裁剪、缝合难度,避免裁剪吻合过程发生输尿管扭曲,此技术可行、实用、安全。

Objective:To investigate the feasibility,practicability and safety of the modified cutting technique in retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction(UPJO).Methods:From Dec.2014 to Nov.2017,the data of 11 patients who underwent laparoscopic dismembered pyeloplasty were collected.In the 11 cases,the"three-points and two sections"positioning was used to locate the lowest point on the lateral side of the renal pelvis and the lowest point of the ureter,and the routine pyeloureteroplasty was completed after cutting,the pre-suture suture knot and completing the first acupuncture.Results:All operations were performed successfully,and no conversion to open surgery was performed.The operation time was 95-195 min,with an average of(125.6±5.2)min.The intraoperative blood loss was 20-70 mL,with an average of(45.5±5.3)mL.No organ damage and no serious complications occurred.Postoperative hospital stay was 6-9 d,with an average of(6.5±1.2)d.11 patients were followed up for 3-23 months.B ultrasound indicated that the hydronephrosis disappeared in 6 cases,and 5 cases decreased by 7-20 mm,7 cases were found without anastomotic stenosis in intravenous urography.Conclusions:The modified cutting technique in retroperitoneal laparoscopic dismembered pyeloplasty is simple,can reduce the difficulty of cutting and stitching,and avoids the ureteral twist during the process of clipping.This technique is feasible,practical and safe.