两定点连续缝合技术在后腹腔镜离断式肾盂成形术中的应用

目的比较后腹腔镜离断式肾盂成形术中"两定点连续缝合技术"和"间断缝合技术"的临床应用。方法回顾性分析2011年1月至2014年2月后腹腔镜离断式肾盂成形术107例。根据肾盂输尿管吻合方法分为"两定点连续缝合技术"组27例(A组),"间断缝合技术"组80例(B组)。对总手术时间、肾盂缩窄时间、肾盂输尿管吻合时间、术后住院时间、引流管拔除时间及漏尿等并发症进行比较。结果 A组手术无中转开放;B组2例中转开放。A组和B组总手术时间平均分别为167.7及191.4min(P=0.003);肾盂输尿管吻合时间平均为20.1及41.5min(P0.001);两组肾盂缩窄时间、术后引流管放置时间、术后住院天数比较差异无统计学意义。其中A组围手术期无漏尿病例,B组围手术期漏尿4例。术后3月复查B超提示A组肾积水消失16例,肾积水不同程度减轻11例;B组肾积水消失54例,肾积水不同程度减轻24例。结论后腹腔镜离断式肾盂成形术中采取"两定点连续缝合技术",可以降低输尿管吻合难度、缩短手术时间、减少术后漏尿发生率。

Application of the fixed two-point running suture anastomosis technique in retro-peritoneal laparoscopic dismembered pyeloplasty

Objective：To compare the clinical application of the fixed two‐point running suture anastomosis technique and interrupted suture anastomosis technique in retroperitoneal laparoscopic dismembered pyeloplasty （RLDP） .Methods Data of 107 patients who underwent RLDP between Jan .2011 and Feb .2014 were retrospectively analyzed .The patients were di‐vided into 2 groups：fixed two‐point running suture anastomosis group （group A , n=27） ,and interrupted suture anastomosis group （group B , n=80） ,according to the ureteropelvic anastomosis method .The operation time ,pelvic suturing time ,uret‐eropelvic anastomosis time ,postoperative hospitalization time ,drainage tube removal time and leakage of urine were observed and compared .Results There was no conversion to open operation in group A while 2 patients were converted to open oper‐ation in group B .The total average operation time was 167 .7 min in group A and 191 .4 min in group B （P=0 .003） .The mean ureteropelvic anastomosis time was 20 .1 min in group A and 41 .5 min in group B （P〈0 .001） .The pelvic suturing time ,post‐operative drainage tube removal time ,postoperative hospitalization time were not significantly different .There was no urine leakage case in the perioperation period in group A but 4 cases in group B .Ultrasound 3 months after operation suggested that hydronephrosis disappeared in 16 and improved in 11 cases in group A .In group B ,hydronephrosis disappeared in 54 cases and improved in 24 cases .Conclusion The fixed two‐point running suture anastomosis technique can reduce the difficulty of uret‐eropelvic anastomosis ,shorten operation time and reduce incidence of postoperative urine leakage in RLDP .