后腹腔镜下肾盂成形术联合膀胱软镜治疗肾盂输尿管连接部梗阻合并肾结石(附5例报告)  

Retroperitoneal laparoscopic pyeloplasty combined with flexible cystoscope in the treatment of ureteropelvic junction obstruction with coexistent stone disease

作　　者：刘启明[1] 马鑫[1] 郑涛[1] 俞鸿凯[1] 张旭[1] 

机构地区：[1]中国人民解放军总医院泌尿外科,北京100853

出　　处：《微创泌尿外科杂志》2013年第3期171-173,共3页Journal of Minimally Invasive Urology

基　　金：国家高技术研究发展计划(863计划)(2012AA021100)

摘　　要：目的:分析后腹腔镜下肾盂成形术联合膀胱软镜治疗肾盂输尿管连接部梗阻(UPJO)合并肾结石的可行性、有效性和安全性.方法:2012年1月～2013年2月对5例UPJO合并肾结石患者行后腹腔镜下肾盂成形术联合膀胱软镜钬激光碎石取石术.记录手术时间、出血量、术后住院时间、术后残石情况、围手术期并发症、中转开腹情况、术后复查情况等.结果:本组无中转开腹手术病例.手术时间90～170 min,平均126 min.1例因结石嵌顿于肾盏内合并盏颈狭窄膀胱软镜无法进入肾盏而残留结石一枚,其他病例结石均取净.术中出血10～30 ml,术后1例出现尿漏,经保守治疗后6天痊愈.术后住院时间6～12 d,平均8d.随访1～9个月,平均6个月,复查5例肾积水均较术前减轻,吻合口无狭窄,无结石复发.结论:后腹腔镜下肾盂成形术联合膀胱软镜是治疗UPJO合并肾结石安全、有效的“双镜联合”治疗方法.Objective:To evaluate the feasibility,efficacy and safety of the retroperitoneal laparoscopic pyeloplasty combined with flexible cystoscope in the treatment of ureteropelvic junction obstruction with coexistent stone disease.Methods:We reviewed data on 5patients undergoing laparoscopic pyeloplasty through retroperitoneal approach and pyelolithotomy with flexible cystoscope between January 2012and March 2013.The clinic parameter involves operational time,blood loss,postoperative hospital stay,the status of stone-free,perioperative complications,conversion to open procedure,the follow-up of radiology.Results:No procedure converted to open surgery.The mean operational time is 126mins(ranged from 90to 170mins).One patient had one residual calculi encrusted in a calyx with obstructive neck indicated by the postoperative radiological image.The blood loss ranged from 10to 30mins. The urinary leak happened in one patient who got recovered after 6days conservative treatment.The mean postoperative hospitality is 8days(ranged 6-12days).The mean period of follow-up is 6months(ranged 1-9months).Conclusions:The retroperitoneal laparoscopic pyeloplasty combined with flexible cystoscope is a feasible,efficient and safe minimally invasive technique in the treatment of ureteropelvic junction obstruction with coexistent stone disease.

关 键 词：腹腔镜 膀胱软镜 肾盂输尿管连接部梗阻 肾结石 

分 类 号：R699[医药卫生—泌尿科学]