首次手术失败后再行腹腔镜肾盂成形术的临床研究

目的:探讨开放或腹腔镜肾盂成形术失败后再次行腹腔镜肾盂成形术的可行性和疗效。方法:从2004年9月~2012年5月,我们对32例肾盂输尿管连接部梗阻行肾盂成形术后再梗阻的患者采用经腹腔入路腹腔镜肾盂成形术治疗。同期开展首次腹腔镜肾盂成形术30例。术前统计两组患者的年龄、性别、体重、左右侧和积水程度,比较两组手术时间、术中术后并发症、住院时间和手术成功率,并把手术时间和术中出血与文献报道的结果相比。手术成功率以临床症状的缓解和影像学上积水和肾功能的改善来判断。两组所有数据均通过SPSS16.0专业软件进行统计,以P0.05为差别有统计学意义。结果:术前两组患者在年龄、性别、左右侧和积水程度上的差别无统计学意义(P0.05)。两组均无严重术中并发症,无中转开放手术者。再次手术组的平均手术时问和术中出血量多于初次手术组(P0.05);两组患者的术后住院时间和手术成功率差别无统计学意义(P0.05)。结论:首次的开放手术或腹腔镜手术会造成肾盂输尿管周围粘连,给再次腹腔镜肾盂成形术带来困难,但只要腹腔镜操作技术熟练,再次行腹腔镜肾盂成形术仍安全可行,还保持了腹腔镜手术微创的优点,且经腹腔途径更容易完成手术。

Laparoscopic pyeloplasty in secondary ureteropelvic junction obstruction due to failed open or laparascopic surgery

Objective：To investigate the feasibility and efficacy of laparoscopic pyeloplasty in patients with sec- ondary ureteropelvic junction obstruction （UPJO） due to failed open or laparoscopic pyeloplasty. Method： From September 2004 to May 2012, 32 patients with secondary UPJO due to failed open surgery and laparoscopic pyelo- plasty who had undergone laparoseopic pyeloplasty were enrolled in this study （group A）. Laparoscopy was car- ried out in all cases using a transperitoneal approach. At the same time, 30 patients were performed primary lapa- roscopic pyeloplasty （group B）. Two groups were similar in age, sex, site of occurrence and degree of hydrone- phrosis. The mean operation time, blood loss, perioperative complications, hospital stay and success rate were al- so recorded and compared between two groups. Symptomatic relief and improved radiographic imaging at the latest follow-up were considered as a standard of successful surgery. The data would show significant differences be- tween these two grops when P value was tess than 0.05. Result： No differences were observed between these two groups in preoperative data including patients age, sex, site of occurrence and degree of hydronephrosis （P〉 0.05）. No intraoperative complication occurred and no conversion to open surgery was needed. The average opera- tive time of group A was longer than group B, and the average blood loss of group A was more than group B （P〈 0.05）. The postoperative hospital stay and surgical success rate between these two groups had no significant differences （P〉0.05）. Conclusion：Primary surgery may cause adhesions around renal pelvis and ureter and brings difficulties to secondary laparoscopic pyeloplasty. For secondary ureteropelvic junction obstruction, laparoscopic pyeloplasty can be performed safely by skilled surgeons. We believe that the transperitoneal approach is helpful in fulfilling the surgery.