输尿管镜钬激光内切开与后腹腔镜肾盂成形术治疗肾盂输尿管连接部狭窄的疗效比较

目的比较经尿道输尿管镜钬激光内切开与后腹腔镜下肾盂成形术治疗肾盂输尿管连接部狭窄(ureteropelvic junction obstruction,UPJO)的疗效。方法 33例UPJO患者按照治疗方法分为输尿管镜组(20例)和后腹腔镜组(13例),比较各项数据。结果两组均无中转开放手术,输尿管镜组手术时间(39.3±7.4)min、术中出血(9.1±6.3)ml、术后住院时间(3.8±1.3)d、平均住院费用(8 937)元;后腹腔镜组手术时间(210.7±30.7)min、术中出血(55.1±17.9)ml、术后住院时间(7.3±2.1)d、平均住院费用(25 477)元,两组间在手术时间、术中出血、术后住院时间、平均住院费用方面差异均有统计学意义。结论输尿管镜钬激光内切开治疗UPJO具有操作更简单、创伤更小、术后恢复更快、花费更低的优势。后腹腔镜肾盂成形术更适合UPJO狭窄段较长、重度肾积水、复杂病例等情况。

Effect comparison of retrograde ureteroscopic endopyelotomy with laparo-scopic retroperitoneal dismembered pyeloplasty for ureteropelvic junction obstruction

Objective To compare the efficacy of retrograde ureteroscopic (RUS) endopyelotomy with laparoscopic retroperitoneal dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction. Methods Thirty-three UPJO cases were divided into two groups:20 cases (the RUS group) were subjected to RUS holmium laser endopyelotomy,and 13 cases were subjected to laparoscopic retroperitoneal dismembered pyeloplasty. Results No case was converted to open surgery in either group;the average operation time was (39.3 ± 7.4) min vs (210.7 ± 30.7) min, respectively;blood loss was (9.1 ± 6.3) ml vs (55.1 ± 17.9) ml, respectively; postoperative hospital stay was (3.8 ± 1.3) d vs (7.3 ± 2.1) d, respectively; and average cost was (8937) yuan vs (25477) yuan, respectively. The differences were significant. Conclusion Retrograde ureteroscopic endopyelotomy using a holmium YAG laser is a safe, effective and economical therapy for treating ureteropelvic junction obstruction. Laparoscopic retroperitoneal dismembered pyeloplasty is effective in treating patients suffering from complicated cases, such as severe hydronephrosis.