30例肾盂输尿管连接部梗阻的原因分析及后腹腔镜下成形手术的治疗经验

目的:探讨成人肾盂输尿管连接部梗阻的原因及腹腔镜下肾盂输尿管连接部梗阻的诊治经验。方法:对我院2006年1月～2009年3月收治的30例(32侧)成人肾盂输尿管连接部梗阻患者的病因和腹腔镜下治疗结果进行回顾性分析。结果:肾盂输尿管连接部狭窄引起梗阻者15例次(约46.8%),异位血管压迫者9例次(约28.1%),纤维索条粘连压迫者4例次(约12.5%),输尿管肾盂高位连接者4例次(约12.5%)。共行腹腔镜下手术32例次,其中离断式肾盂成形术28例次,肾盂Y-V成形术4例,纤维条索松解4例,异位血管切断3例。30例患者手术全部成功,术中无并发症发生。术中平均出血量70 ml。术后3个月～1年进行复查随访,自觉症状消失或明显好转,B超检查提示肾盂积水有不同程度减轻,排泄性尿路造影(IVU)检查患肾功能恢复良好者28例(93.3%);失访1例。结论:腹腔镜下肾盂成形术效果满意,而且损伤小、恢复快,是解决肾盂输尿管连接部梗阻的最佳方法。

Characteristics of UP JO and Clinical Signification of Retroperitoneal Laparoscopic Pyeloplasty in 30 Patients

Objective：To explore the cause of ureteropelvic junction obstruction and the clinic value of Retroperitoneal Laparoscopic Pyeloplasty in the treatment of ureteropelvic junction obstruction in adults. Methods： The clinical data including etiology and outcomes of 30 adult patients with UPJO was performed by retroperitoneal laparoscopic pyeloplasty in our hospital from January 2006 to March 2009. Results.. Etiological factors included ureteropelvic junction stricture in 15 cases （46. 8 % ） , fiber chords in 4cases （12. 5% ） , high location of the junction in 4 cases （12. 5% , and ectopic vessels in 9 cases （28.1%）. A total of 32 sides of surgical procedures were performed , including 28 cases-times of Anderson-Hynes pyeloplasty, 4 cases-times of Y-V pyeloplasty , 4 casestimes of chord brisement., and 3 cases-times of ectopic vessel resection. All the procedures were successfully completed. The average bleeding volume was 70 ml. Ultrasound B and IVU investigation showed that hydronephrosis reduced and symptom relieved in most cases during 3 to 12 months after operation. B-ultrasound suggest different degrees of hydronephrosis are reduced excretory urography （IVU） examination suffering from renal function recovery in 28 cases （93 . 3%）; 1 case lost. Conclusions Retroperitoneal Laparoscopic pyeloplasty is safe and effective in treating patients suffering from ureteropelvic junction obstruction with minimal trauma and quick recovery.