摘要：
Objective To explore the feasibility of laparoscopic Anderson-Hynes pyeloplasty for pediatric giant hydronephrosis (GH) caused by ureteropelvic junction obstruction (UPJO). Methods From April 2008 to May 2015, a total of 83 GH patients (84 kidneys) caused by UPJO who underwent laparoscopic Anderson-Hynes pyeloplasty performed by a single surgeon team were retrospectively analyzed .Postoperatively , the relief of hydronephrosis was evaluated with anterior-posterior diameter of dilated pelvicaliceal system with continuous B-ultrasonography .All the patients were divided into either internal drainage or external drainage group .The operative time , complications , length of hospitalization , and the ratio of hydronephrosis remission were evaluated between the two different pattern of drainage . Results All the operations were successfully completed laparoscopically .No conversion to open surgery was required .The patients were followed up for 3-24 months (mean, 16 months).At the 3, 6, 12, and 24 postoperative months , there were 33 and 47 cases, 30 and 44 cases, 27 and 32 cases, and 12 and 16 cases followed in the external and internal drainage groups , respectively .Postoperatively , the hydronephrosis was relieved in all the cases , without significant difference between the two groups ( P>0.05).There was no statistical difference in the operative time between the external and internal drainage groups [(161.9 ±23.8) min vs.(164.0 ±24.7) min, t=-0.388, P=0.699].No pneumoperitoneum related complications or gastrointestinal injuries occurred .Postoperative complications were found in 18 cases (21.7%, 18/83), 14 of which (16.9%, 14/83 ) were Clavien-Grade Ⅰ complications and the rest of the 4 cases ( 4.8%, 4/83 ) were Clavien-Grade Ⅱ complications.There was no significant difference in postoperative complications between the two groups [14.3%(5/35) vs.27.1%(13/48),χ2 =2.408, P=0.661].There was significant difference in length of hospitalization between the external and internal drainage groups [(9.8 ±1.3) d vs.(7.8 ±1.2) d, t =7.239, P =0.000]. Conclusions Laparoscopic Anderson-Hynes pyeloplasty for GH is safe and effective .Both external and internal drainage have satisfactory results .%目的 评估腹腔镜下Anderson-Hynes肾盂成形术治疗小儿肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)所致巨大肾积水的可行性,探讨术后肾盂尿液引流方式的选择.方法 2008年4月~2015年5月采用经腹腔入路腹腔镜下Anderson-Hynes肾盂成形术治疗83例UPJO所致巨大肾积水,术后连续B超检测肾集合系统扩张分离的前后径(anterior-posterior,AP),评价术后肾积水缓解情况.术后采用内引流和外引流2种肾盂尿液引流方式,按引流方式分为2组,比较2组手术时间、并发症、术后住院时间.结果 83例均在腹腔镜下顺利完成Anderson-Hynes肾盂输尿管成形术,无中转开放手术.术后随访3~24个月,平均16个月,术后3、6、12、24个月外引流组和内引流组分别随访33、47例,30、44例,27、32例,12、16例,术后肾积水均缓解,2组均无统计学差异(P>0.05),无再手术.外引流组和内引流组手术时间无统计学差异[(161.9±23.8)min vs.(164.0±24.7)min,t=-0.388,P=0.699].术中均未发生与气腹有关的并发症,无肠道及脏器损伤.术后2组出现并发症18例(21.7%,18/83),其中14例(16.9%,14/83)为ClavienⅠ级,4例(4.8%,4/83)为ClavienⅡ级,2组术后并发症发生率无明显差异[14.3%(5/35)vs.27.1%(13/48),χ2=2.408,P=0.661].外引流组和内引流组术后住院时间有显著性差异[(9.8±1.3)d vs.(7.8±1.2)d,t=7.239,P=0.000].结论 腹腔镜下Anderson-Hynes肾盂成形术治疗UPJO引起的小儿巨大肾积水是安全、有效的可选择方式,2种引流方式的疗效均良好.
