后腹腔镜离断式肾盂成形术在肾盂输尿管连接部梗阻治疗中的应用

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。     

开放手术与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效果比较

目的：通过与开放性。肾盂成形术的临床效果比较,评价后腹腔镜离断式肾盂成形术的临床价值。方法：回顾性分析后腹腔镜离断式肾盂成形术64例（A组）及开放性肾盂成形术48例（B组）的临床资料,就两组患者一般资料、手术时间、术中出血量、术后肠道功能恢复时间、术后止痛药用量、术后住院天数、术后并发症及术后肾积水复发率等指标进行比较。根据数据类型选用x^2检验、两样本t检验或Wilcoxon秩和检验,P〈0．05差异有统计学意义。结果：两组患者的一般资料相似,差异无统计学意义（P〉0．05）,具有可比性。后腹腔镜离断式肾盂成形术在手术时间、术中出血量、术后肠道功能恢复时间、术后止痛药用量、术后住院天数、术后并发症等方面优于开放性肾盂成形术,差异有统计学意义（P〈0．05）,而术后肾积水复发率方面差异无统计学意义（P〉0．05）。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疗效肯定,与传统的开放性手术相比,创伤小、恢复快、术后近期疗效相当,是目前治疗肾盂输尿管连接部梗阻较理想的手术方法,值得进一步推广。     

改进后腹腔镜下离断式肾盂成形术(附65例报告)

目的探讨改进后腹腔镜下离断式肾盂成形术的临床应用价值。方法 2003年5月～2010年12月完成65例后腹腔镜下离断式肾盂成形术,裁剪肾盂时暂不将肾盂和输尿管完全离断,保持肾盂壁下角与输尿管壁连接,尽量裁剪旋转不良扩张肾盂的背侧叶以矫正肾盂的腹侧转位,采用腹腔镜下体外和体内相结合的方法置入双J管。结果本组65例均获成功,无中转开放手术。手术时间60～195 min,平均82.4 min,术中出血量10～50 ml,平均25.2 ml。无周围脏器损伤,无严重并发症发生。2例术后吻合口漏尿,2～3周后自愈。术后住院时间6～9 d,平均6.5 d。52例随访3～90个月,平均25.1月,B超提示肾积水消失18例3,1例肾盂积水较术前减少7～24 mm,平均15.5 mm3,例肾积水较术前无明显较少;41例复查IVU,38例无吻合口狭窄,3例吻合口狭窄(行输尿管镜下内切开术,随访9、12、16个月,复查IVU无吻合口狭窄)。结论改进后腹腔镜下离断式肾盂成形术使难度降低,疗效满意。     

后腹腔镜辅助小切口离断式肾盂成形术治疗肾盂输尿管连接部梗阻

目的 探讨后腹腔镜辅助小切口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。方法 采用后腹腔镜辅助，小切口、放大镜下吻合的离断式肾盂成形术治疗UPJO患者12例。男8例，女4例。年龄5～48岁。B超及尿路造影显示UPJO伴有肾积水，其中B超提示重度肾积水4例，中度6例，轻度2例。IVU显影良好9例，显影差3例。结果12例手术均获成功。手术时间100～180min，平均127min；出血量30～100ml，平均70ml；术后住院时间5～8d，平均5．6d；无手术并发症。术后随访3～12个月，经B超和IVU检查，UPJ吻合口无狭窄，肾积水减轻，肾功能有不同程度改善。结论 后腹腔镜辅助小切口离断式肾盂成形术是治疗UPJO的较实用、微创的手术，值得临床选择应用。     

腹腔镜离断式肾盂输尿管成形术治疗UPJO肾积水230例经验总结

目的:探讨腹腔镜离断式肾盂输尿管成形术治疗肾盂输尿管连接部梗阻(UPJO)肾积水的临床疗效及总结手术经验。方法:回顾性分析我院2012年10月～2018年10月收治的230例UPJO患者的临床资料。其中先天性UPJO 180例,获得性UPJO 50例,含肾盂输尿管连接部(UPJ)成形术后狭窄10例,输尿管镜下钬激光碎石或经皮肾镜取石术后狭窄30例及球囊扩张术后狭窄10例。采用经腹腹腔镜行离断式肾盂输尿管成形术,术前及术中对体位、Trocar布置、游离和吻合各环节做了细节优化。术后定期随访,分别于拔除双J管后1、3、6、12个月门诊复查B超检查及尿常规,测量肾盂前后径扩张程度及肾实质厚度。结果:所有手术均成功完成,5例中转开放。平均随访时间12(6～36)个月,B超提示肾积水较术前减轻,部分患者ECT及CTU提示肾实质厚度增加,梗阻程度较前减轻,患肾功能不同程度恢复,术前腰背部不适、腹痛及发热等症状主观上明显改善。6例术后出现UPJ再狭窄,3例经输尿管镜检+双J管再置2个月后拔管梗阻缓解,2例行再次腹腔镜肾盂输尿管成形术后改善,1例失访。结论:腹腔镜离断式肾盂输尿管成形术治疗UPJO肾积水安全、有效,术后并发症发生率低,改善肾积水和肾功能结果满意。严格掌握手术适应证、耐心细致的操作和正确处理术中遇到的困难是做好腹腔镜离断式肾盂输尿管成形术的关键。     

后腹腔镜与开放离断肾盂成形术的临床效果比较

目的：通过与开放离断肾盂成形术的效果比较,评价后腹腔镜离断肾盂成形术的临床价值。方法：回顾性分析的腹腔镜离断肾盂成形术56例（A组）及开放离断肾盂成形术10例（B组）的临床资料,就两组手术时间、术中出血量、术后肠道功能恢复时间、术后止疼药用量、术后住院天数,并发症和成功率等指标进行比较。根据数据类型选用X^2检验,成组t检验或Mann-Whitey U检验。结果：A组在术中出血量,术后肠道功能恢复时间,术后止产药用量。术后住院天数方面优于B组,差异有统计学意义（P〈0.01）;并发症和成功率与B组相当,差异无统计学意义（P〉0.05）。结论：后腹腔镜离断肾盂成形术是一种治疗肾盂输尿管连接部梗阻的微阳、安全、有效的方法,但存在较明显的学习期。熟练后可在较短时间内完成手术。     

后腹腔镜下离断式肾盂成形术

目的:探讨后腹腔镜离断式肾盂成形术的临床效果。方法:腹腔镜下通过后腹腔途径对肾盂输尿管连接部(UPJ)狭窄5例患者行离断式肾盂成形术。结果:5例手术均获成功,手术时间80~180m in,平均110m in;术中出血量30~90m l,平均50m l;漏尿1例;术后住院8~15d,平均10d。术后随访1~12个月,UPJ吻合口无狭窄,肾积水改善。结论:后腹腔镜肾盂成形术微创,安全、效果好,值得推广。     

后腹腔镜下Anderson-Hynes离断性肾盂成形术在肾盂输尿管连接部梗阻治疗中的应用

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"。     

后腹腔镜辅助小切口离断肾盂成形术治疗肾盂输尿管连接部梗阻

目的通过与常规后腹腔镜离断肾盂成形术的临床效果比较,评价后腹腔镜辅助小切口离断肾盂成形术治疗肾盂输尿管连接部（ureteropelvic junction,UPJ）梗阻的临床价值。方法回顾性分析2004年1月～2006年11月在我院行离断肾盂成形术成人患者47例临床资料,其中行后腹腔镜辅助小切口组（A组）22例（腋后线12肋下长4 cm小切口）,后腹腔镜组（B组）25例。对2组手术时间、术中出血量、平均气道阻力、呼气末CO2分压、术后胃肠道功能恢复时间、引流管拔除时间、术后住院时间、尿漏发生率、术后肾积水缓解情况、肾小球滤过率改善情况进行统计分析。结果无一例术中并发症发生。与B组比较,A组手术时间短[（92.9±16.3）min vs（155.8±18.6）min,t=-12.251,P=0.000],术中出血量多[（18.9±6.3）ml vs（13.6±6.7）ml,t=2.782,P=0.008]但无临床意义,术中平均气道阻力小[（15.6±2.6）cm H2O vs（26.9±4.3）cm H2O,t=-10.715,P=0.000],呼气末CO2分压低[（36.0±6.9）cm H2O vs（51.6±6.7）cm H2O,t=-7.855,P=0.000]。2组术后胃肠道功能恢复时间、引流管拔除时间、术后住院时间、术后尿漏发生率和肾积水缓解情况差异无显著性。结论后腹腔镜辅助小切口离断肾盂成形术是治疗UPJ梗阻安全、有效、微创的治疗方法。     

腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部梗阻42例报告

目的：探讨经腹腔途径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）的临床效果。方法：采用经腹腔途径腹腔镜下离断式肾盂成形术治疗UPJO患者42例,男25例,女17例,平均年龄30（12～50）岁。其中左侧24例,右侧18例;重度肾积水17例,中度肾积水22例,轻度肾积水3例。结果：42例手术均顺利完成,无中转开放手术者。其中3例伴肾盂结石者同时取出肾盂结石;5例迷走血管为梗阻原因者,将受压段输尿管切除后于血管腹侧吻合。平均手术时间110（80～200）min,平均术中出血量25（10～50）ml。术后漏尿2例,分别于术后7天及40天消失,其余患者术后4～5天拔出引流管,6～7天拔出导尿管;术前表现为腰腹部胀痛者术后症状减轻或消失,术后平均住院时间8（6～11）d。术后4～6周拔出双J管,未见特殊不适。40例随访3～36个月,行彩超及IVu等影像学检查,2例患侧UPJ吻合口狭窄伴肾积水,行输尿管镜下丝状电极内切开术后治愈;余38例中,肾积水消失15例,肾积水减轻18例,肾积水无加重5例。结论：经腹腹腔镜下离断式肾盂成形术视野清晰,易于缝合,创伤小,恢复快,是治疗UPJO较为理想的手术方法。     

后腹腔镜治疗输尿管腔外良性压迫所致肾盂输尿管连接部梗阻

目的探讨后腹腔镜治疗输尿管腔外良性病变压迫所致肾盂输尿管连接部梗阻的优势。方法21例良性病变压迫所致肾盂输尿管连接部梗阻患者，其中纤维索带压迫7例，异位血管压迫11例，腔静脉后输尿管压迫3例。术前均经B超，静脉肾盂造影（IVP），16层螺旋CT尿路造影（CTU）确诊后采用后腹腔镜下解除肾盂输尿管连接部外在压迫，行肾盂成形术。结果手术均顺利且证实术前诊断，手术时间1～3h，平均94min；出血量50-120mL，平均95mL；术后住院时间5—7d，平均5．6d。术后随访3个月到1年，肾脏、输尿管积水明显好转。结论CTU对良性病变压迫所致肾盂输尿管连接部梗阻的定位及定性诊断具有特殊价值。后腹腔镜下解除压迫，行肾盂成形术具有损伤小、术后恢复快和住院时间短等优点，有良好的临床应用前景。     

后腹腔镜肾盂成形术治疗肾盂输尿管连接处梗阻

目的:评价后腹腔镜肾盂成形术治疗肾盂输尿管连接处梗阻(ureteropelvic junction obstruction,UPJO)技术要点及临床疗效。方法:通过后腹腔途径在腹腔镜下对30例UPJO患者行离断式肾盂成形术,其中男18例,女12例,年龄在16～48岁;异常血管压迫4例,合并泌尿系感染8例。结果:30例手术均获成功,无一例中转开放手术。手术时间120～235min,平均105min;出血量85～135ml,平均115ml。30例术后随访6～24个月,经B超、IVU检查,肾盂输尿管吻合口未见明显狭窄,患肾积水明显减轻或消失,临床症状消失。结论:后腹腔镜肾盂成形术是一种创伤小、安全可靠、疗效确切的微创手术方法。     

Laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in children

Objectives:   To present our initial experience with laparoscopic pyeloplasty and to evaluate the safety and short-term outcome of this technique in children.
Methods:   Thirteen kidney units in twelve children underwent laparoscopic dismembered pyeloplasty for the management of ureteropelvic junction obstruction (UPJO) at our institution between 2005 and 2008. Patient age at surgery was 18–177 months (mean 89.8 months). There were six boys and six girls. Ten had unilateral UPJO with a normal contralateral kidney, one had bilateral UPJO and one had UPJO of a solitary kidney. We used 3- and 5-mm instruments for grasping, blunt dissection, incising and suturing to facilitate safe and precise surgery. The outcome was measured by the operative time and resolution of obstruction and symptoms.
Results:   Median operative time was 275 min (range 154–420). There was a slight relationship between age and operative time. No major perioperative complications occurred in any cases. Median renal pelvic anterior–posterior diameter at ultrasonography significantly decreased from 8.6 cm (range 3.8–22.0) preoperatively to 3.9 cm (1.0–8.9) postoperatively ( P  < 0.05). The median pre- and postoperative split renal function on diuretic renography in unilateral cases was 37.3% (range 29.7–46.4) and 39.5% (27.8–48.0), respectively. Overall, successful resolution of UPJO was observed in 12 of 13 kidneys (92.3%).
Conclusions:   Laparoscopic pyeloplasty represents a safe and effective option in the surgical treatment of children with UPJO.     

Retroperitoneal dismembered pyeloplasty: Initial experiences

AIM: To review the results of our first 40 cases of retroperitoneal dismembered pyeloplasty and to compare them with series of open and other minimally invasive treatments of pelviureteric junction (PUJ) obstruction. Also to compare our first 20 cases with the second 20 cases to see if there was an improvement in results with experience. METHODS: A retrospective review of the first 40 laparoscopic pyeloplasties performed by a single lead surgeon at two institutions was performed. The diagnosis of PUJ obstruction was confirmed with an intravenous urogram as well as a renogram prior to surgery. A retroperitoneal, dismembered pyeloplasty was routinely performed with three or four ports. All patients were followed up with an intravenous urogram, renogram and review of symptoms at 4 months and annual renogram after that. RESULTS: Average operation time was 236 min and this appeared to decrease with experience. Two cases had to be converted to open operations. The mean hospital stay was 3.4 days. Out of the 40 patients, 34 have had successful laparoscopic operations with total symptomatic relief as well as radiologically proven deobstruction. There were four major complications with 3 patients going on to have redo open pyeloplasty operations. There were seven minor complications. CONCLUSIONS: In our experience, retroperitoneal dismembered pyeloplasty is an effective and safe means of treating PUJ obstruction. Our results seem to be comparable with series of open pyeloplasty and other laparoscopic series and are better than some other minimally invasive techniques.     

Dismembered pyeloplasty in children: A review of 5 years single center experience

AIM: Dismembered pyeloplasty is the treatment of choice for significant ureteropelvic junction obstruction in children. In the present study, we review our experience in 103 pediatric patients and present the clinical characteristics, the surgical treatment and its complications and the long term results. METHODS: We have reviewed the medical charts of 103 consecutive patients who underwent dismembered pyeloplasty in a 5-year period, from 1997 to 2002. Preoperative data, short- and long-term complications and outcome were recorded. Imaging studies included urinary tract sonography and dynamic renal scans, the results of which were compared pre- and postoperatively. RESULTS: Most of our patients were boys (81%), diagnosed prenatally (78%). We had no major complications and acceptable incidence of minor complications. Postoperative outcome was excellent, with decreased hydronephrosis (81%), improved renal drainage (87%) and preserved or improved renal function (89%). CONCLUSION: Dismembered pyeloplasty can be performed with a low incidence of minor complications, no major complications and excellent long-term outcome.     

Cost-effective laparoscopic pyeloplasty: Single center experience

OBJECTIVE: Laparoscopic pyeloplasty (LPP) is a minimally invasive treatment option for ureteropelvic junction (UPJ) obstruction. We report here our experience of performing cost-effective LPP on 24 patients at a single center. METHODS: Between October 1999 and March 2002, LPP was performed in 24 patients (17 male, seven female; age range 8-51 years) including two patients who had failed previous endourologic treatments. In two patients with concomitant renal stones, laparoscopic pyelolithotomy was also performed. LPP was conducted in a cost-reductive manner by both transperitoneal (n = 12) and retroperitoneal (n = 12) access. To reduce the cost, an indigenous balloon to create the retroperitoneal space, reusable ports, ordinary polyglactin suture and intracorporeal free-hand suturing were employed. To reduce operative time, antegrade stenting was also performed in some cases. RESULTS: Laparoscopic Anderson-Hynes pyeloplasty was performed in 16, Foley Y-V pyeloplasty in five and Fenger pyeloplasty in three patients. One patient required conversion to open surgery due to tension at the anastomosis site during Anderson-Hynes pyeloplasty. The mean operating time, blood loss, analgesic (pethidine) requirement, duration of drain and hospital stay for the retroperitoneal and transperitoneal groups were 170.3 and 187.6 min, 102.2 and 145.9 mL, 125 and 136.4 mg, 2.1 and 2.5 days, and 3.4 and 4.3 days, respectively. No significant complications were encountered apart from prolonged ileus in three patients in the transperitoneal group. The mean follow-up period was 10.8 months with a range of 2-24 months. Postoperative renal scan was performed at 3 months in 21 patients, and 1 year in 11 patients. There was evidence of equivocal obstruction in one patient, but there were no obstructions in the remaining patients. CONCLUSION: Although LPP is technically demanding, it is emerging as a viable, minimally invasive alternative to open pyeloplasty for UPJ obstruction with a success rate similar to that of open pyeloplasty. It allows the duplication of open surgery steps (unlike endoscopic procedures), thereby providing durable and sustained results. LPP can also be performed safely, effectively and efficiently in a cost-efficient manner.     

腹腔镜辅助体外肾盂成形术（附23例报告）

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。     

经脐单孔腹腔镜肾盂离断成形术临床分析

目的 探讨经脐单孔腹腔镜手术治疗肾盂输尿管连接部狭窄的手术技巧与临床应用价值.方法 2009年8月至2010年3月对15例肾盂输尿管连接部狭窄患者行经脐单孔腹腔镜肾盂离断成形术.男12例,女3例;平均年龄20(12～55)岁.均采用利尿性肾图、IVU、磁共振尿路造形术(MRU)等检查确诊,其中左侧9例,右侧6例.依病变部位在脐患侧缘行长约3.5 cm的切口建立单孔操作通道.采用Olympus四方向可弯曲腹腔镜,主要采用标准腹腔镜器械.肾盂离断成形方法基本同普通腹腔镜方法.结果 手术均成功,无中转开放手术者.平均手术时间为90(75～145)min.术中未出现器官损伤,术后未出现尿漏.患者平均住院时间6(4～8)d.术后随访4～6个月,患者腰痛症状消失,IVU和(或)B超检查肾积水明显减轻或消失,无吻合口再狭窄.结论 经脐单孔腹腔镜手术治疗肾盂输尿管连接部狭窄安全、有效.

Abstract：

Objective To evaluate the surgical techniques and clinical applications of single-port transumlilical laparoscopic dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO). Methods From August 2009 to March 2010, 15 patients were treated with single-port transumbilical laparoscopic dismembered pyeloplasty. There were 12 males and 3 females,aged 12 to 55 years with an average age of 20 years, who were diagnosed by diuretic renography,IVU, and MRU et al. A single umbilical incision of 3. 5cm was made for single-port trocar and a flexible-tip 0°digital video-laparoscope was used in all cases. The procedures were performed according to the methods used in classical laparoscopic dismembered pyeloplasty with general instruments. ResultsAll operations were performed successfully without conversion to open surgery. The mean operative time was 90 (75-145) min, and the mean hospital stay length was 6 days. No organs injury occurred during operation, and no urine leakage was found afer operation. The symptoms of low back pain disappeared and hydronephrosis reduced apparently or dispeared without any anastomotic stenosis after follow-up of 4-6 months. Conclusions Single-port transumbilical laparoscopic dismembered pyeloplasty is feasible, effective and safe for the treatment of UPJO.