经腹腹腔镜联合软镜治疗肾盂输尿管连接部梗阻合并肾结石

Laparoscopic pyeloplasty combined with soft endoscope for the treatment of ureteropelvic J unction obstruction with renal calculi

目的探讨腹腔镜肾盂成形联合电子膀胱软镜或输尿管软镜治疗肾盂输尿管连接部梗阻(UPJO)合并肾结石的安全性和有效性。方法回顾性分析2018年1月至2021年12月解放军联勤保障部队第九四二医院收治的29例UPJO合并肾结石患者的临床资料,男13例,女16例,左侧16例,右侧13例;术前泌尿系CT三维重建(CTU)检查提示UPJO合并肾结石,肾集合系统分离5~8 cm,平均(5.5±2.1)cm,结石直径0.8~3.5 cm,平均(1.5±0.9)cm。术中先利用腹腔镜游离出扩张的肾盂和输尿管上段,在肾盂拟裁剪处先切开1 cm,置入软镜,直视下用三边或四边套石网篮取出结石,较大结石取出困难时置入钬激光碎石,结石清除后采用Anderson‐Hyens法行腹腔镜肾盂成形术。结果29例患者均一期完成手术,结石均完全清除,1例术中置入戳卡导致肝损伤中转开放手术;手术时间120~260 min,平均(130.10±30.3)min,术后下地时间24~72 h,平均(38.5±16.2)h,平均住院时间(7.5±2.6)d。术后8周拔除双J管(D-J管),随访7~29个月,29例肾积水均明显改善,腰疼缓解,术后无严重并发症发生。结论腹腔镜肾盂成形术联合电子膀胱软镜或电子输尿管软镜同期治疗UPJO合并肾结石安全、可靠,创伤小、恢复快,清石率高,值得临床推广应用。

Objective To investigate the safety and effectiveness of laparoscopic pyeloplasty combined with flexible electronic cystoscope or flexible ureteroscopy in the treatment of ureteropelvic J unction obstruction(UPJO)with renal calculi.Methods A retrospective analysis of the clinical data of 29 UPJO patients with renal calculi admitted from January 2018 to December 2021,including 13 males and 16 females,16 cases on the left side and 13 cases on the right side.Three-dimensional CT of the urinary system before operation Reconstruction(CTU)examination revealed that UPJO was associated with renal calculi.The renal collecting system was separated by 5 to 8 cm,with an average of(5.5±2.1)cm.And the stone diameter was 0.8 to 3.5 cm,with an average of(1.5±0.9)cm.Laparoscopy was used to free the expanded renal pelvis and upper ureter during the operation.The renal pelvis was incised 1cm at the intended cutting site,and an electronic soft cystoscope or electronic soft ureteroscope was placed.Under direct vision,it was taken out with a three-sided or four-sided stone basket.Holmium laser lithotripsy was inserted when larger stones were difficult to remove.After the stones were removed,the Anderson-Hyens method was used to perform laparoscopic pyeloplasty.Results All 29 patients in this group completed the operation in one stage,and all the stones were completely removed.One case was converted to open surgery due to the implantation of a stick card during the operation.The operation time was 120-260 min,with an average of(130.1±30.3)min.The postoperative time to the ground was 24-72 h,with an average of(38.5±16.2)h.And the average hospital stay was(7.5±2.6)d.The double J tube(D-J tube)was removed 8 weeks after the operation.After a follow-up of 7-29 months,29 cases of renal hydrops were significantly improved,the back pain was relieved,and no serious complications occurred after the operation.Conclusion Laparoscopic pyeloplasty combined with electronic soft cystoscope or electronic soft ureteroscopy for simultaneous treatment of UPJO complicated with kidney stones is safe and reliable.