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1.
目的探讨一种改良的腹腔镜肾盂成形术.方法肾盂输尿管连接部梗阻32例,经腹腔镜下游离肾盂及部分输尿管上段,然后扩大经肾盂输尿管连接部的切口至2.5~3 cm,采用开放手术方式进行肾盂输尿管成形操作.结果32例手术均获成功.术中证实肾下极异位血管压迫1例,原发管腔狭窄31例.手术时间40~70 min,平均52 min;术中出血量20~30 ml,平均23 ml.无手术并发症.27例随访7~15个月,平均9.6月,腰部胀痛消失,静脉肾盂造影(intravenous pyelography,IVP)检查吻合口均无梗阻,B超肾集合系统分离术前2.0~4.2 cm,平均2.8 cm,术后17例降至1.0~2.3 cm,平均1.5 cm,余10例无分离.结论改良的腹腔镜肾盂成形术简化了腹腔镜操作,缩短了手术时间,值得临床推广应用.  相似文献   

2.
目的探讨后腹腔镜离断式肾盂成形术治疗肾盂输尿管连接部梗阻的临床价值。方法回顾性分析后腹腔镜离断式肾盂成形术治疗10例肾盂输尿管连接部梗阻患者的临床资料。其中男7例,女3例,年龄9~39岁。左侧6例,右侧4例。10例患者均有不同程度腰部胀痛史,病程3~30个月。结果 10例手术均获成功,无中转开放手术病例,术中证实异位血管压迫3例,原发性肾盂输尿管连接部狭窄7例。手术时间120~240min,平均180min,术中失血量50~100ml,平均75ml,术后住院7~9d。围手术期所有病例无漏尿等并发症发生。随访3~18个月,超声提示患者肾积水程度减轻,IVU提示肾盂输尿管连接部吻合口无狭窄,术前显影延迟病例显影时间提前,所有患者腰痛症状缓解。结论后腹腔镜离断式肾盂成形术治疗肾盂输尿管连接部梗阻技术可行,安全有效,其远期疗效有待进一步观察。  相似文献   

3.
目的介绍后腹腔镜Anderson-Hynes术治疗肾盂输尿管连接部梗阻的方法和初步经验。方法2006年3月至2007年12月,采用后腹腔镜Anderson—Hynes肾盂成形术治疗肾盂输尿管连接部梗阻患者11例,其中男性7例,女性4例,平均年龄27岁,重度积水8例,轻中度积水3例。结果11例手术均获成功,手术时间为120~300min,平均为180min,术中出血量为20~80ml,平均为50ml。术中术后无严重并发症发生。术后随访3~20个月,腰部疼痛症状均消失,复查B超有2例肾脏积水完全消失,其余9例复查静脉肾盂造影肾盂积水均较术前明显减轻,未见吻合口狭窄结论后腹腔镜Anderson—Hynes肾盂成形术治疗肾盂输尿管连接部梗阻技术可行、安全有效,对于有丰富腹腔镜技术经验的术者可取代开放手术。  相似文献   

4.
目的:探讨肾盂输尿管连接部梗阻(UPJO)的后腹腔镜手术治疗方法及临床价值.方法:对20例UPJO患者行后腹腔镜肾盂成形术治疗.结果:全部患者均一次性手术成功,手术时间90~150 min.平均120min术中出血量20~50 ml,平均35 ml;术后住院时间7~10天,平均8天.术后1例出现漏尿,术后10天消失,余无并发症.随访6~52个月,平均20个月,腰痛症状消失,本组患者术后行B超、IVU榆查示肾盂输尿管连接部吻合口无狭窄,肾积水得到改善.结论:后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻是安全有效的微创手术方法.  相似文献   

5.
后腹腔镜离断性肾盂成形术(附22例报告)   总被引:35,自引:9,他引:26  
目的:探讨后腹腔镜离断性肾盂成形术的临床效果。方法:采用后腹腔途径对22例确诊为肾盂输尿管连接部(UPJ)梗阻的患者施行腹腔镜离断性肾盂成形术。结果:22例手术全部成功。手术时间70~180min,平均108min;术中出血量5~50ml,平均16ml;术后住院时间6~8d,平均7.2d。围术期无并发症。16例术后获随访3~15个月,UPJ吻合口无狭窄,肾积水得到改善。结论:后腹腔镜离断性肾盂成形术是治疗UPJ梗阻有效、安全及微创的方法,值得临床推广使用。  相似文献   

6.
目的探讨后腹腔镜技术在肾盂输尿管连接部梗阻手术中的应用价值。方法42例肾盂输尿管连接部梗阻患者接受后腹腔镜下尿路重建手术治疗。结果42例手术均获成功。手术时间为90~260min,平均180min;术中出血量为40~120ml,平均75m1;术后住院时间为3d~12d,平均7.4d;39例获得随访,随访时间1个月~5年,平均15.3个月。所有患者临床症状消失,影像检查示肾积水减轻,连接部梗阻无复发。结论后腹腔镜技术治疗肾盂输尿管连接部梗阻,具有安全,微创,痛苦小,恢复快等优点,对于有经验的术者可替代部分开放手术。  相似文献   

7.
目的:探讨后腹腔镜下Anderson-Hynes离断式肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床价值。方法:回顾性分析后腹腔镜Anderson-Hynes离断式肾盂成形术治疗65例单侧UPJO患者的临床资料。其中男41例,女24例,年龄18~56岁,平均36岁。左侧39例,右侧26例。65例患者均有不同程度腰部胀痛史,病程6~42个月。结果:65例手术均获成功,无中转开放手术病例,术中证实异位血管或纤维束压迫18例,原发性肾盂输尿管连接部狭窄47例。手术时间115~212min,平均150min,术中失血量30~50ml,平均37ml,术后住院7~10d。围手术期2例出现漏尿,无其他并发症。随访6~48个月,超声提示患者肾积水程度减轻,IVU提示肾盂输尿管连接部吻合口无狭窄,术前显影延迟病例显影时间提前,所有患者腰痛症状消失或缓解。结论:后腹腔镜离断式肾盂成形术治疗UPJO技术可行,安全有效,有望逐渐替代开放手术成为治疗UPJO的"金标准"。  相似文献   

8.
腹腔镜手术治疗肾盂输尿管连接部狭窄19例   总被引:3,自引:0,他引:3  
目的 评价腹腔镜手术治疗肾盂输尿管连接部狭窄(ureteropelvic junctiono bstruction,UPJO)的疗效。方法 采用经腹路径对19例UPJO行离断式。肾盂输尿管成形术。打开侧腹膜,以。肾下极为标志游离出。肾盂输尿管连接部,切除狭窄部分,端端吻合肾盂输尿管并留置双J管。结果 19例手术全部成功,手术时间110~240min,平均150min。术中出血量50~100ml,平均80ml,无严重并发症发生。术后住院6~10d,平均7.8d。19例随访3~15个月,平均6个月,14例静脉尿路造影(intrarenous urography,IVU)无吻合口狭窄。结论 腹腔镜下离断式肾盂输尿管成形术治疗UPJO有效、可行,可以替代开放手术。  相似文献   

9.
后腹腔镜辅助下小切口肾盂成形术(附8例报告)   总被引:2,自引:0,他引:2  
目的:探讨后腹腔镜辅助下小切口离断性肾盂成形术的临床效果。方法:采用后腹腔途径,在腹腔镜辅助下作小切口,为8例肾盂输尿管连接部(UPJ)梗阻的患者施行离断性肾盂成形术。结果:8例手术全部成功。手术时间65~110min,平均78min;术中出血量10~50ml,平均30ml;术后平均住院时间9d。围手术期无并发症发生。术后随访5~18个月,UPJ吻合口无狭窄,肾积水得到改善。结论:后腹腔镜辅助下小切口离断性肾盂成形术是治疗UPJ梗阻有效、安全、微创且简便易行的手术方法,值得进一步在临床上推广。  相似文献   

10.
目的探讨腹腔镜辅助体外肾盂成形术治疗肾盂输尿管连接处梗阻(UPJO)的临床疗效。方法UPJO23例经腹腔在腹腔镜下游离肾盂及上段输尿管,延长病变部位体表投影处戳口1-2cm,并通过此戳口将病变部位提及腹壁外,再行肾盂成形术。结果23例手术均获成功。手术时间为45-85min,平均62min;术中出血量10-50mL,平均28mL;术后住院7-8d,平均7.2d;术中术后无任何并发症。17例随访3-20个月,平均12.5月,经静脉尿路造影(IVU)检查,显影明显改善,吻合口无梗阻,B超提示肾积水消失或明显减轻。结论腹腔镜辅助体外肾盂成形术治疗UPJO结合了开放手术与腹腔镜手术的优点,使手术创伤减小,手术时间缩短,手术操作难度降低,术后恢复快,住院天数减少,效果满意,值得临床推广应用。  相似文献   

11.
AIM: Reconstructive laparoscopic procedures have been recognized as a less invasive treatment than conventional open procedures. However, although the laparoscopic pyeloplasty has also been accepted as useful, few findings have been reported relevant to the retroperitoneal approach. To elucidate its effectiveness and safety, laparoscopic surgery via the retroperitoneal approach was examined in our institution. Furthermore, the importance of laparoscopic observation for ureteropelvic junction and urine passage ureteropelvic junction without indwelling ureteral stent. METHODS: Between July 1998 and December 2004, 13 men and 15 women underwent laparoscopic retroperitoneal surgery for ureteropelvic junction obstruction. The mean patient age was 33.6 years (range: 13-70 years). Methods of repair were determined by intraoperative findings for the relationship between the ureteropelvic junction and surrounding vessels. An indwelling ureteral stent was removed before initiating laparoscopic operation to observe the relationship between ureteropelvic junction and aberrant vessels more precisely. RESULTS: An aberrant renal vessel was found in 13 patients (46%). Dismembered pyeloplasty was carried out in 21 patients, Y-V plasty in five patients and Hellstrom technique in two patients. Ureteral transposition was not required in dismembered pyeloplasty cases. All patients achieved retroperitoneoscopic pyeloplasty without open conversion. The mean operative time was 272 min (range: 155-490 min). The mean estimated blood loss was 44 mL (range: 10-200 mL). No major complications were observed during the intraoperative period, but urinary tract infection occurred in two patients in the postoperative period. In all patients except one, obstruction was improved or resolved. CONCLUSIONS: Laparoscopic retroperitoneal surgery is not only able to repair ureteropelvic junction obstruction, but can also be done safety and less invasively. We believe that laparoscopic observation without indwelling stent will contribute to a more appropriate choice of pyeloplasty.  相似文献   

12.
腹腔镜手术治疗肾盂输尿管移行处狭窄   总被引:1,自引:0,他引:1  
目的:评价腹腔镜手术治疗肾盂输尿管移行处狭窄(UPJ)的临床效果。方法:经腹腔路径对19例确诊的UPJ行腹腔镜离断式肾盂输尿管成形术,男12例,女7例,肾脏积水重度6例,中度8例,轻度5例,IVU13例显影良好,6例显影延迟。结果:19例手术全部成功,手术时间110~240min,平均150min,术中出血50~100m1,术后住院6~10d,平均7.8d,无严重并发症发生,随访3~15个月,肾积水程度均减轻,IVU无吻合口狭窄。结论:腹腔镜下离断式肾盂输尿管成形术治疗UPJ有效、可行,可以替代开放手术。  相似文献   

13.
后腹腔镜下离断式肾盂成形术   总被引:4,自引:2,他引:2  
目的 探讨后腹腔镜下肾盂成形术的技术特点及临床应用价值. 方法 采用后腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部狭窄患者41例.男20例,女21例.平均年龄30(12~45)岁.左侧23例,右侧18例.有腰痛症状者31例,无症状体检发现者10例.其中孤立肾1例、马蹄肾3例、合并结石3例.41例均经临床及影像学检查证实.术中采用顺行置管和连续缝合技术.手术成功标准为患者症状消失,利尿肾图、IVU检查结果明显改善. 结果 41例平均手术时间160(95~300)min,平均出血量35(20~80)ml,无中转开放手术者.术中发现异位血管10例,均将输尿管置于血管腹侧.3例合并结石者均完整取出结石.术后发生漏尿1例,延长引流管放置时间,术后14 d漏尿停止.未发生其他并发症.平均住院时间7.5(5~14)d.平均随访28(13~52)个月,1例术后12个月因吻合口狭窄行开放手术治愈,手术成功率97.6%(40/41). 结论 后腹腔镜离断式肾盂成形术适应证广,效果肯定,可能成为治疗肾盂输尿管连接部狭窄的标准方法.  相似文献   

14.
目的:探讨腹部小切口腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部梗阻的临床疗效。方法:共治疗13例。经腹腔途径腹腔镜下充分游离出肾盂和输尿管上段,仔细观察肾盂输尿管连接部,剪断狭窄段的远端,将一个穿刺孔延长至4cm左右,直视下进行肾盂输尿管吻合。结果:13例手术均获成功,无围手术期并发症。术后随访1~23个月,吻合口无狭窄,肾积水减轻,肾功能有不同程度改善。结论:本术式安全、有效,适合在刚开展腹腔镜手术的医院推广。  相似文献   

15.
目的:探讨俯卧位背侧入路后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床应用价值。方法:回顾性分析18例UPJO患者的临床资料。其中男12例,女6例,年龄18~65岁,平均31岁。所有患者行肾脏超声、静脉肾盂造影或多层螺旋CT尿路成像和逆行造影检查,其中2例行逆行造影证实迷走血管压迫,8例无症状患者行同位素肾图证实上尿路梗阻。结果:18例均在后腹腔镜下顺利完成手术。手术时间85~205min,平均125min;术中出血量35~80ml,平均54ml;术后住院6~12天,平均8.7天。围手术期未出现并发症。术后4~6周拔除双J管。随访时间9~20个月,平均14.7月,17例痊愈,总治愈率(94.4%)。1例发生再狭窄,二次行开放手术治愈。结论:俯卧位背侧入路后腹腔镜离断性肾盂成形术治疗UPJ0安全可行。经背侧入路后腹腔镜手术的成功实施为临床手术路径的研究提供一种新的思路。  相似文献   

16.
Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction   总被引:3,自引:0,他引:3  
PURPOSE: Laparoscopic pyeloplasty has become a viable option for the treatment of select patients with primary ureteropelvic junction obstruction with success rates similar to those of open surgery. However, little has been written on the application of this technique for secondary ureteropelvic junction obstruction. We report the largest series of secondary ureteropelvic junction obstruction managed by laparoscopic pyeloplasty. MATERIALS AND METHODS: Between March 1994 and March 2001, 36 patients underwent laparoscopic transperitoneal pyeloplasty for secondary ureteropelvic junction obstruction. The patients had undergone an average of 1.3 ureteropelvic junction procedures (range 1 to 4) prior to presentation, including cutting balloon retrograde endopyelotomy in 28, antegrade endoscopic endopyelotomy in 7, retrograde endoscopic endopyelotomy in 4, retrograde balloon dilation in 4 and open pyeloplasty in 3. A preoperative diagnosis of recurrent obstruction was confirmed by renal scan in 31 cases, retrograde pyelography in 2 and computerized tomography in 3. Of the 31 patients who underwent spiral computerized tomography angiogram 87% had crossing vessels. Laparoscopic repair comprised dismembered pyeloplasty in 31 cases, Fengerplasty in 3 and flap repair in 2. Postoperative renal scan or excretory urography objective followup was available for all patients at a mean of 10 months (range 3 to 40). Postoperative subjective patient well-being was assessed using an analog pain scale at a mean followup of 21.8 months (range 3 to 85). RESULTS: Average operative time was 6.2 hours (range 2.7 to 10). Average hospital stay was 2.9 days (range 1 to 7). One intraoperative complication occurred, that is bleeding necessitating conversion to an open procedure. Postoperative complications occurred in 8 cases, including anastomotic leakage in 4, and urinary tract infection, pneumonia, atelectasis, fever, bilateral upper extremity weakness and stone formation 2 months postoperatively in 1 each. On excretory urography, furosemide renal scan or the Whitaker test 32 of 36 patients (89%) had a widely patent ureteropelvic junction. Two patients (5.5%) had equivocal radiographic studies but were asymptomatic. In 2 patients the ureteropelvic junction was obstructed by renal scan. One patient had an indwelling stent for renal function deterioration and 1 was asymptomatic. Hence, 34 of the 36 patients (94%) had a reasonable objective response. Overall a 50% or greater decrease in pain was seen in 32 of 36 patients (89%). In the 4 patients with a less than 50% decrease in pain objective renal scans showed an open ureteropelvic junction. As such, the overall success rate of a greater than 50% decrease in pain, a patent ureteropelvic junction and stable or improved function of the affected renal unit was 83% (30 of 36 patients). CONCLUSIONS: For secondary ureteropelvic junction obstruction, laparoscopic pyeloplasty can be performed safely with a success rate comparable to that of standard open pyeloplasty. The patient benefits of laparoscopic ureteropelvic junction repair of secondary ureteropelvic junction obstruction are similar to the benefits of laparoscopic repair of primary ureteropelvic junction obstruction.  相似文献   

17.
目的:探讨后腹腔镜肾盂成形术治疗儿童先天性肾盂输尿管连接部梗阻(UPJO)的可行性、手术技巧及临床应用价值。方法:回顾性分析26例先天性UPJO患儿经后腹腔镜肾盂成形术治疗的临床资料。20例患儿因患侧腰腹胀痛就诊,2例因血尿就诊,4例体检时发现。并发肾盂结石4例。在后腹腔镜下游离肾盂及输尿管上段,斜行切除狭窄段,用5-0可吸收线全层缝合输尿管近端与肾盂做V-Y吻合。留置支架管及肾盂造瘘管。结果:26例手术均获得成功。随访3~18个月,复查静脉尿路造影示吻合口无狭窄,肾积水、肾功能均得到改善。结论:采用后腹腔镜肾盂成形术治疗儿童先天性UPJO效果显著,安全可行,较开放手术创伤小,可以替代开放手术成为儿童先天性UPJO的首选治疗方式。  相似文献   

18.
BACKGROUND: Laparoscopic pyeloplasty is rapidly becoming an acceptable procedure for ureteropelvic junction obstruction in the pediatric population. We present our experience with transperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction in pelvic kidneys in pediatric patients. METHODS: A transperitoneal laparoscopic approach was used for performing a pyeloplasty in 4 patients, 7 months to 8 years of age (mean age, 3.14), with ureteropelvic junction obstruction in a pelvic kidney. RESULTS: Average operative time was 2.1 hours (range, 1.5 to 2.8). Mean hospital stay was 2.15 days (range, 1 to 7). No intraoperative complications were noted. CONCLUSIONS: Transperitoneal laparoscopic pyeloplasty for pelvic kidneys is feasible in the pediatric population, and preliminary results appear to offer the same outcome as that seen in orthotopic kidneys.  相似文献   

19.
目的:探讨腹腔镜辅助技术应用于小儿肾盂输尿管连接部狭窄(UPJO)的方法。方法:采用腹腔镜辅助小切口经腹腔进行离断性肾盂成形术。结果:手术均获成功。手术时间50~80m in,平均65m in;术中出血量20~50m l,平均35m l;术中、术后均无输血,未发生明显的并发症。结论:腹腔镜辅助小切口离断性肾盂成形术具有损伤小、术后康复快和住院时间短等优点,有良好的临床应用前景。  相似文献   

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