后腹腔镜治疗儿童先天性肾盂输尿管连接部梗阻的价值

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。

Application of retroperitoneal laparoscopy in the treatment of pediatric congenital ureteropelvic junction obstruction

Objective:To evaluate the surgical techniques and clinical effects of retroperitoneal laparoscopic pyeloplasty in pediatric congenital ureteropelvic junction obstruction.Methods:The clinical data of 26 cases(15 males and 11 females, the age ranged from 5 to 10 years and mean 7 years) treated by retroperitoneal laparoscopy were retrospectively analyzed. Stenosis was resected and Anderson-Hynes pyeloplasty was carried out.Results:Retroperitoneoscopic pyeloplasty was performed successfully in all 18 cases. The operative time ranged from 150 to 240 min (mean 200 min). Bleeding volume ranged from 40 to 70 ml (mean 50 ml) and no blood transfusion needed. The mean postoperative hospital stay was 6 d (range, 4-7 d).18 cases were followed up for 3 to 18 months. Hydronephrosis was obviously extenuated and renal function was improved. The stoma had no stenosis.Conclusions:It was suggested that retroperitoneal laparoscopic pyeloplasty was safe, effective and less traumatic for pediatric congenital ureteropelvic junction obstruction.