改进后腹腔镜下离断式肾盂成形术(附65例报告)

摘要

Objective To evaluate modified retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction. Methods A retrospective analysis was performed on 65 consecutive patients, who underwent retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction at our institution from May 2003 to December 2010. We partially cut the pelvis and ureter so that to keep the pelvis connecting to the wall of the ureter, and then we clipped the dorsal pelvis as far as possible to correct the malrotation of the kidney; after that a double-J tube was inserted under a laparoscope. Results The procedure was completed without conversion to open surgery in all the cases. The mean operation time was 82.4 minutes (60 - 195 minutes) , and the mean intraoperative blood loss was 25. 2 ml (10-50 ml). No injury to adjacent organs or severe complications occurred in our patients. Two of them developed anastomotic urinary leakage, and was cured spontaneously in 2 to 3 weeks. The mean postoperative hospital stay of the 65 patients was 6. 5 days (6-9 days). Follow-up was achieved in 52 of the patients for 3 to 90 months (mean, 25. 1 months) , during which, B-ultrasonography showed that hydronephrosis disappeared in 18 patients, decreased in 31 cases (by 7 -24 mm with a mean of 15.5 mm) , and not improved in 3 cases; 41 patients received reexamination by IVU, which showed anastomotic stenosis in 3 of them. The 3 patients then received ureteroscopic surgery and was followed up for another 9, 12 and 16 months afterwards, during which IVU didn't reveal stenosis. Conclusion Modified retroperitoneal laparoscopic dismembered pyeloplasty is less difficult with good effect.%目的 探讨改进后腹腔镜下离断式肾盂成形术的临床应用价值. 方法 2003年5月～2010年12月完成65例后腹腔镜下离断式肾盂成形术,裁剪肾盂时暂不将肾盂和输尿管完全离断,保持肾盂壁下角与输尿管壁连接,尽量裁剪旋转不良扩张肾盂的背侧叶以矫正肾盂的腹侧转位,采用腹腔镜下体外和体内相结合的方法置入双J管. 结果 本组65例均获成功,无中转开放手术.手术时间60～195 min,平均82.4 min,术中出血量10～50 ml,平均25.2 ml.无周围脏器损伤,无严重并发症发生.2例术后吻合口漏尿,2～3周后自愈.术后住院时间6～9d,平均6.5d.52例随访3～90个月,平均25.1月,B超提示肾积水消失18例,31例肾盂积水较术前减少7 ～ 24 mm,平均15.5 mm,3例肾积水较术前无明显较少；41例复查IVU,38例无吻合口狭窄,3例吻合口狭窄(行输尿管镜下内切开术,随访9、12、16个月,复查IVU无吻合口狭窄).结论 改进后腹腔镜下离断式肾盂成形术使难度降低,疗效满意.