后腹腔镜术治疗成人肾盂输尿管交界处梗阻性病变的临床研究

摘要

Objective To investigate the clinical diagnosis and treatment of adult ureteropelvic junction ob‐struction lesions .Methods 140 cases of adult ureteropelvic junction obstruction lesions were selected and randomly divided into two groups .67 cases in the control group and 73 cases in the observation group had the comparability .All patients underwent intravenous urography (IVU ) ,among them 93 cases were simultaneously performed the retro‐grade urography (RGU ) and 28 cases were conducted the percutaneous nephrolithotomy urography .The control group adopted the conventional open surgery ,while the observation group was implemented the retroperitoneal lapa‐roscopic surgery .The situation of treatment and recovery in the two groups was performed the statistics and compari‐sons .Results All patients were diagnosed during surgery .The diagnostic accuracy by the above mentioned imaging reached up to 100% .The intraoperative blood loss volume and operative time in the observation grroup were signifi‐cantly less than those in the control group ,the analgesic drugs amounts were significantly less than those in the con‐trol group ,the fasting time was significantly shorter than that in the control group ,the ambulation time ,postoperative bowel recovery time and postoperative hospital stay were significantly shorter than those in the control group ,and the incidence rate of postoperative complications was significantly lower than that in the control group ,the differences were statistically significant (P< 0 .05) .The recurrence rate of postoperative hydrocephalus had no statistical differ ‐ence between the two groups (P> 0 .05) .Conclusion Adult ureteropelvic junction obstruction lesions can be diag‐nosed by pyelography ,retrograde urography and percutaneous pyeloureterography ,in the aspect of treatment ,retro‐peritoneal laparoscopic surgery after mastering its chracteristics has the obvious superiority due to the characteristics of small injury and rapid recovery .%目的：探讨成人肾盂输尿管交界处梗阻性病变的临床诊断和治疗方法。方法选取成人肾盂输尿管交界处梗阻性病变患者140例，随机分为对照组（67例）和观察组（73例）。所有患者均进行静脉尿路造影（IVU ），其中同时行逆行尿路造影（RGU ）93例，28例行经皮肾穿刺尿路造影。对照组患者采取常规开腹术，观察组患者实施后腹腔镜手术，比较两组患者的治疗情况和恢复情况。结果所有患者均在术中确诊，通过上述影像学诊断的准确率高达100％。观察组患者术中出血量和手术时间均明显少于对照组，止痛药用量明显少于对照组，禁食时间明显短于对照组，下床活动时间、术后肠道恢复时间、术后住院时间均明显短于对照组，术后并发症发生率明显少于对照组，差异均有统计学意义（P＜0．05）。两组患者术后积水复发率比较，差异无统计学意义（P ＞0．05）。结论成人肾盂输尿管交界处梗阻性病变可以通过肾盂造影、逆行尿路造影以及经皮肾盂穿刺造影联合的方式进行诊断，而治疗方面，后腹腔镜手术具有损伤小、恢复快等特点。