改良腹腔镜肾盂成形术

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.

A modified laparoscopic pyeloplasty

Objective To discuss a modified laparoscopic pyeloplasty. Methods A total of 32 patients presenting ureteropelvic junction obstruction underwent a modified laparoscopic pyeloplasty which included the dissection of the ureteropelvic junction under laparoscope and the pyeloplasty through an extended trocar-incision 2.5~3 cm in length as open surgery did. Results The operation was successfully completed in all the 32 patients.Intraoperative findings demonstrated renal inferior polar compression by ectopic blood vessels in 1 patient and primary ureteropelvic stricture in 31 patients.The operative time was 40~70 min(mean,52 min) and the intraoperative blood loss was 20~30 ml(mean,23 ml).No surgery-related complications were observed.Follow-up checkups in 27 patients for 7~15 months(mean,9.6 months) showed disappearance of lumbar distending pain.Intravenous pyelography revealed no anastomotic obstruction.In 17 patients presenting the separation of the renal collective system,(B-ultrasonography) revealed a decrease from 2.0~4.2 cm(mean,2.8 cm) preoperatively to 1.0~2.3 cm(mean,1.5 cm) postoperatively.Conclusions The modified laparoscopic pyeloplasty simplifies the operation performance and shortens the operation time.