后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻

目的 评价后腹腔镜肾盂输尿管成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床效果.方法 收集2008年6月～2011年2月共11例UPJO合并肾中重度积水患者,行后腹腔镜下作V-Y成形术.结果 所有患者手术均顺利完成,静脉肾盂造影(IVU)提示造影剂通过良好,肾积水均明显改善.结论 后腹腔镜治疗肾盂输尿管连接部梗阻微创、安全、有效,值得推广.     

开放手术与腹腔镜治疗肾盂输尿管连接部狭窄的疗效比较

[目的]对腹腔镜肾盂成形术和开放手术在治疗肾盂输尿管连接部狭窄(UPJO)的疗效进行比较,并总结和探讨腹腔镜肾盂成形术在UPJO治疗中的临床应用价值.[方法]回顾性分析2009年4月到2012年8月在本院行手术治疗的UPJO患者86例.其中进行腹腔镜下离断式肾盂成形术40例,开放式手术46例.比较两种方法的手术时间、术中出血量、术后胃肠道恢复时间、住院时间、术后并发症和术后伤口疼痛等情况.[结果]所有86例腹腔镜手术与开放式手术组手术均获得成功.腹腔镜手术组未出现中转开放手术的情况,腹腔镜手术组术中出血量少于、术后胃肠功能恢复时间、术后住院天数均低于开放手术组(P＜0.01),而手术时间则明显高于开放手术组(P＜0.01),两组的手术成功率无明显差别(P＞0.05).[结论]腹腔镜离断式肾盂成形术治疗UPJO是一种微创、安全的术式,可考虑将其作为UPJO手术治疗的首选术式用来代替开放手术.     

后腹腔镜下肾盂成形术治疗肾盂输尿管连接部梗阻疗效观察

[目的]探讨后腹腔镜下肾盂成形本治疗肾盂输尿管连接部梗阻的疗效及技术要点.[方法]本院43例肾盂输尿管连接部梗阻(UPJO)的患者,其中24例采用后腹腔镜下肾盂成形术治疗,19例行开放性肾盂成形术治疗,比较两组的疗效.[结果]后腹腔镜组术中出血量,术后止痛药用量,术后住院时间均小于开放组(P＜0.05),两组术后各有1例尿漏.术后随访并发症和肾积水改善两组比较无统计学意义(P＞0.05).[结论]后腹腔镜肾盂成形术治疗UPJO安全、有效,较开放手术途径创伤小,术后恢复快.     

后腹腔镜离断式肾盂成形术11例

目的 探讨后腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的技术要点和临床价值.方法 回顾性分析后腹腔镜下离断式肾盂成形术治疗UPJO 11例患者的临床资料及疗效.结果 手术均获成功,手术时间120～175min,平均150 min,术中出血量40～100mL,平均55 mL;术后8～11 d出院,平均住院时间9.3d.术后1个月拔除内支架管,随访3～6个月静脉肾盂造影提示造影剂通过良好,肾积水均得到明显改善.结论 后腹腔镜下离断式肾盂成形术是治疗UPJO的一种安全有效的手术方法,其损伤小、恢复快、住院时间短、效果佳,值得推广.     

后腹腔镜下离断肾盂成形术8例报告

目的探讨后腹腔镜下离断肾盂成形术的临床效果。方法采用后腹腔径路对8例确诊为肾盂输尿管连接部梗阻(UPJO)的患者行腹腔镜下离断肾盂成形术。结果8例手术均获成功,手术时间110~165 min,平均130 min;出血量30~90 ml,平均55 ml。术后住院7~15 d,平均10 d。术后有2例患者出现暂时性漏尿。术后随访3~6个月,肾积水较术前均有所好转,无再手术病例。结论后腹腔镜下离断肾盂成形术是治疗UPJO有效、安全、微创的治疗方法。     

后腹腔镜离断式肾盂成形术（附17例报告）

目的：探讨后腹腔镜离断式肾盂成形术的临床价值。方法：采用后腹腔镜技术对17例肾盂输尿管连接部梗阻（UPJO）患者实施离断式肾盂成形术。结果：17例手术全部成功,手术时间95-165 min,平均130 min,术中出血20-90 mL,平均50 mL。术后15例随访3-16个月,IVU检查吻合口无狭窄,患肾积水减轻或消失,腰部疼痛消失。结论：后腹腔镜离断式肾盂成形术创伤小、安全、有效,是肾盂输尿管连接部梗阻（UPJO）新的治疗选择,可替代传统的开放手术。     

后腹腔镜精准辅助小切口离断肾盂成形术治疗小儿肾盂输尿管连接部梗阻（附22例报告）

目的探讨后腹腔镜精准辅助小切口离断肾盂成形术治疗小儿肾盂输尿管连接部梗阻(UPJO)的手术技巧和临床价值。方法 22例小儿UPJO行后腹腔镜精准辅助小切口离断肾盂成形术。其中,男15例,女7例,年龄6个月~8岁,平均3.5岁;左侧13例,右侧7例,双侧肾积水2例。结果辅助小切口长度1.5~4.0 cm,平均2.6 cm,手术时间42~95 min,平均63 min,术中出血量5~30 ml,平均15 ml,术后住院时间5~12 d,平均6.6 d。围手术期尿漏1例,因术后护理不当夹闭导尿管导致,术后延长伤口引流管留置时间后治愈。术后随访3~24个月,复查B超及尿路造影(CTU)显示肾积水及肾功能均得到改善,尿常规正常。结论对于部分小儿UPJO,后腹腔镜精准辅助小切口离断肾盂成形术是一种微创、安全而有效的手术治疗方法。     

后腹腔镜与开放性肾盂成形术治疗肾盂输尿管连接部梗阻的术后效果观察与护理

目的 分析比较后腹腔镜肾盂成形术与传统开放性肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)术后各疗效指标及并发症情况,总结两种术式不同的护理方法.方法 回顾性分析2009年6月～2011年6月我院UPJO行肾盂成形术患者120例,其中,后腹腔镜手术组65例,传统开放组55例.比较两组患者术后疗效及并发症情况.结果 后腹腔镜组患者术后疗效确切.下床活动时间、术后禁食时间、术后胃肠功能恢复时间、止痛药应用次数、术后住院天数方面明显优于开放组(P＜0.05).但后腹腔镜手术组有其特殊的并发症存在.结论 后腹腔镜肾盂成形术具有创伤小、痛苦少、恢复快等优点,能够提高护理工作效率和质量.但必须为该术式患者提供针对性的护理措施.     

经脐单孔与三孔腹腔镜肾盂成形术治疗儿童肾盂输尿管连接部梗阻效果比较

目的 比较肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)患儿采用经脐单孔腹腔镜肾盂成形术和三孔腹腔镜肾盂成形术治疗的效果,探讨经脐单孔腹腔镜肾盂成形术治疗UPJO的优势.方法 UPJO患儿58例,行经脐单孔腹腔镜肾盂成形术38例为单孔组,行三孔腹腔镜肾盂成形术20...     

后腹腔镜下离断式肾盂成形术(附19例报告)

目的 评价后腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床疗效及其可行性.方法 采用后腹腔镜下离断式肾盂成形术对19例诊断为动力性梗阻的肾盂输尿管连接部(UPJ)狭窄患者(不包括因外在纤维索及异位血管压迫所致者)进行治疗.结果 19例手术均获成功,无1例中转改开放手术,平均手术时间165 min( 125～245 min);出血量78 mL(55～165 mL),均无输血.术后平均住院时间7.5d.2例出现尿漏,分别于术后11、12d消失.术后随访6～36个月(平均26个月),IVP检查UPJ吻合口未见狭窄,手术侧肾盂积水明显减轻或基本消失(中度积水3例、轻度积水5例、肾积水消失11例).结论 后腹腔镜下离断式肾盂成形术具有术中创伤小、术后恢复快、疼痛减轻的优点,效果优于开放手术,是既安全又有效的微创手术方法.     

Role of robotics in the management of secondary ureteropelvic junction obstruction

Patients with recurrent ureteropelvic junction obstruction (UPJO) present a treatment dilemma to urologists. Second-line therapies have previously been shown to fail at a higher rate than the initial therapeutic procedure. We report our experience with robotic-assisted, dismembered pyeloplasty in patients with secondary UPJO. Since November 2002, 44 robotic-assisted laparoscopic pyeloplasties (RALPs) have been performed at our institution. Of these, seven patients had undergone previous definitive treatment for UPJO. Anderson-Hynes-dismembered pyeloplasty was the preferred reconstructive technique in all patients. The patients were divided into two groups: primary pyeloplasty patients (group 1) and secondary pyeloplasty patients (group 2). Variables examined include operative time, estimated blood loss (EBL), length of hospital stay (LOS) and success rates. All operations were completed laparoscopically, and there were no conversions to open surgery in either group. Mean operative time was 60 min longer in the secondary pyeloplasty group compared with primary cases, but the EBL, LOS and success rates were similar. A patent UPJ was confirmed in both groups by renal scan and/or excretory urography (intravenous pyelogram) examinations. RALP is a viable option in select patients with recurrent UPJO after previous endoscopic or open surgical repair. As expected, operative times were longer in these patients due to a more challenging dissection (p < 0.05). However, the magnification afforded by the robot allows for a precise dissection, and subsequently, there was no significant increase in blood loss, hospital stay or perioperative morbidity in our series (p > 0.05).     

离断性肾盂成形术治疗肾盂输尿管连接部梗阻60例

目的总结离断性肾盂成形术治疗肾孟输尿管连接部梗阻（UPJO）的诊治体会。方法分析60例UPJO患者的临床资料。其中肾孟输尿管连接部狭窄40例,肾孟输尿管高位连接12例,迷走血管压迫5例,纤维条索压迫3例。均采用Anderson-Hynes术。结果术后随访6～36个月,分别行B超、静脉肾孟造影检查、MRI检查,有58例（96.7%）肾积水消失或明显减轻,1例（1.7%）无明显变化,1例（1.7%）肾积水加重。结论离断性肾孟成形术治疗UPJO疗效显著。     

利尿肾动态显像评价离断式肾盂成形术治疗单侧肾盂输尿管连接部狭窄

目的 应用利尿肾动态显像评价离断式肾盂成形术治疗单侧肾盂输尿管连接部狭窄（UPJO）的疗效,分析与术后患肾功能改善可能相关的因素。方法 回顾性分析因单侧UPJO接受离断式肾盂成形术的患者42例。全部患者均于手术前后行利尿肾动态检查,且对侧肾功能正常。以注射显像剂后2~3 min时的患肾摄取率作为其相对肾功能（RRF）。根据肾图曲线对速尿的反应（RFS）情况,将引流梗阻性质分为机械性梗阻和非机械性梗阻。观察术后患肾功能改善与引流改善状况;分析术后患肾功能改善与术后引流改善、术前患肾功能以及术前梗阻类型之间的相关性。结果 术前患肾RRF为（40.40±13.45）%,术后为（44.26±13.35）%,较术前有明显提高（P=0.01）。术后患肾功能改善组、无变化组与恶化组的引流改善率分别为53.33%（8/15）、56.00%（14/25）和50.00%（1/2）,术后患肾功能改善与引流改善无明显相关性（P=0.21）。术后患肾功能改善与术前患肾功能及梗阻类型均无明显相关性（P=0.40、0.60）。结论 离断式肾盂成形术可提高UPJO患肾功能,并改善部分患肾引流状况,且术后患肾功能改善不依赖于引流改善;但术前患肾功能及梗阻类型尚无法用于术后患肾功能改善的预测。     

小儿经腹肠系膜间隙入路腹腔镜下肾盂成形术的疗效观察

目的 总结经腹肠系膜间隙入路行腹腔镜下肾盂成形术的临床经验,探讨该术式治疗小儿左侧肾盂输尿管连接部狭窄导致肾盂积水的疗效.方法 回顾性分析2014年5月-2020年5月该院18例采取经腹肠系膜间隙入路行腹腔镜下肾盂成形术患儿的临床资料.其中,男10例,女8例,年龄3～14岁,平均(5.7±2.9)岁,均为左侧.均采用经...     

Care of the patient undergoing robotic-assisted laparoscopic pyeloplasty

Laparoscopic pyeloplasty as a treatment for ureteropelvic junction obstruction has shown comparable success rates with open pyeloplasty techniques. The use of robotic technology to assist during laparoscopic pyeloplasty procedures has been encouraged by the steep learning curve for laparoscopic surgical skills, and the complexity of laparoscopic suturing. Robotic technology provides the surgeon with the ability to filter out any physiologic hand tremor, more degrees of freedom of movement than traditional laparoscopic instruments, the ability to scale movement to provide better control for microsurgery, better ergonomics during surgery, and three-dimensional vision. Details of the procedure and specific nursing care of the patient undergoing robotic-assisted laparoscopic pyeloplasty at the University of Iowa Hospital and Clinics are described.     

Recurrent Severe Abdominal Pain in the Pediatric Patient

Background

Ureteropelvic junction obstruction (UPJO) is a blockage occurring at the junction of the ureter and the renal pelvis. Pediatric patients with UPJO pose a diagnostic challenge when they present to the emergency department (ED) with severe recurrent abdominal pain if there is not a level of suspicion for this condition.

Objectives

Our aim was to review presentation of UPJO to the ED, methods of diagnosis, and treatment of this common but often overlooked condition.

Case Report

We report on 2 patients, a 9-year-old and 3-year-old, who had multiple presentations to health care providers and the ED with intermittent and recurrent abdominal pain. Subsequent testing, including ultrasound (US) and computed tomography (CT) with diuretic-recreated symptoms, revealed UPJO. Open pyeloplasty was performed, resulting in complete resolution of symptoms.

Conclusions

UPJO is an important diagnosis to consider when patients present to the ED with recurrent abdominal pain. US can be helpful in suspecting the diagnosis, but often CT, magnetic resonance urography, or diuretic scintigraphy is required for confirmation. Diuretics can be used to aid diagnostic testing by reproducing abdominal pain at the time of imaging. Referral to a urologist for open pyeloplasty is definitive treatment for this condition.     

Prenatal diagnosis, management and outcome of fetal uretero-pelvic junction obstruction

Prenatal diagnosis, management and outcome were studied retrospectively in 24 cases of unilateral and bilateral uretero-pelvic junction obstruction (UPJO). Moderate-to-marked pelvic dilatation was documented in 19 out of 24 cases. The low morbidity and mortality observed in this study are probably determined by the late (third trimester) detection of UPJO, resulting in an underestimation of the prevalence of more severe renal pathology. Amniotic fluid was increased in 4 out of 14 cases of unilateral UPJO and in 5 out of 10 cases of bilateral UPJO, the underlying mechanism of which is still unclear. There was no oligohydramnios. The incidence of extrarenal structural pathology was low, i.e., 3 out of 24 cases. A close agreement could be demonstrated between pre- and postnatal sonographic grading of pelvic dilatation. However, postnatal ultrasonic grading of pelvic dilatation correlated poorly with the degree of functional obstruction as determined by IVP and lasix renography. Despite the severity of pelvic dilatation in the majority of cases, enlarged kidneys were revealed by postnatal clinical examination in only three instances, underlining the importance of prenatal sonographic detection of UPJO.