后腹腔镜肾盂成形术13例临床分析

目的探讨后腹腔镜肾盂成形术的适应证选择、手术技巧及临床应用价值。方法回顾性分析后腹腔镜肾盂成形术治疗13例输尿管肾盂连接部梗阻(UPJO)的临床资料。男7例,女6例。钬激光腔内切开失败1例;高位输尿管开口1例;狭窄段>2cm或UPJ完全闭锁3例;单纯重度肾积水4例;异位血管压迫2例;合并肾盂结石2例。结果13例手术均获成功。手术时间120￣200min,平均175min;出血量60￣110mL。术后平均住院时间7.5d。围手术期无并发症。随访3￣19个月,UPJ吻合口无狭窄,肾积水、肾功能均得到改善。结论后腹腔镜肾盂成形术是治疗UPJ梗阻的有效、可行的微创手术,可替代开放手术,成为腔内切开治疗失败、高位输尿管开口、异位血管压迫或伴有重度肾积水、结石的肾盂输尿管连接部梗阻患者的首选术式。

Clinical analysis of retroperitoneal laparoscopy for pyeloplasty

[Objective] To evaluate the choice of indications and clinical effect of retroperitoneoscopic pyeloplasty and review its technical details. [Methods] To retrospectively analyze clinical data of 13 cases of retroperitoneoscopic dismembered Anderson-Hynes type pyeloplasty. There were 7 male patients and 6 female. 1 case failed in endopyelotomy, 1 case high versus dependent ureteral insertion, 3 cases constriction segment >2 cm, 4 cases heavy hydronephrosis, 2 cases crossing vessel, and 2 cases complicated with pelvic stone. [Results] All cases underwent retroperitoneoscopic pyeloplasty successfully. The operation time ranged from 120 to 200 minutes (mean 175 minutes), the blood loss ranged from 60 to 110 mL(mean 75 mL), the mean postoperative hospital stay was 7.5 days. There were not intraoperative complications. During the follow-up period of all cases, there was no ureteric stricture, hydrocele had been improved. [Conclusion] Laparoscopic pyeloplasty offers a less invasive alternative to open surgery with decreased morbidity, shorter hospital stay, and faster convalescence. Laparoscopic pyeloplasty should become the operation of first choice in cases of hydronehprosis secondary to crossing vessel, when there is great pyelic dilation, and for the treatment of failures of previous endopyelotomy and high versus dependent ureteral insertion.