小儿上尿路梗阻的腹腔镜手术治疗  

Peritoneoscopic Surgery for Pureile Upper Urinary Tract Obstruction

作　　者：李爽[1] 郭晖[1] 戴世希[1] 王军[1] 雷伟[1] 韩杰[1] 马慧[1] 

机构地区：[1]武汉市儿童医院泌尿外科,武汉430016

出　　处：《医学新知》2009年第6期342-343,346,共3页New Medicine

摘　　要：目的探讨腹腔镜手术治疗小儿上尿路梗阻所致肾积水病变的治疗效果，明确腹腔镜手术在小儿泌尿外科的应用价值。方法采用腹腔镜手术治疗小儿上尿路梗阻32例（29例经后腹腔，3例经腹），其中22例行离断式。肾盂输尿管成形术，3例输尿管息肉切除肾盂输尿管成形术，3例肾盂输尿管切开取石术，1例仅行迷走血管离断术，3例经腹腔腹腔镜输尿管裁剪膀胱再植术。结果32例腹腔镜手术成功。手术时间60～260（平均170）min，术中平均出血量15～20ml。术后3～6个月随访32例肾积水症状消失。B超检查肾集合系统分离减轻。8例行IVU检查肾显影增快，输尿管通畅。3例输尿管再植术后行膀胱逆行造影无反流。结论腹腔镜治疗小儿上尿路梗阻疾病可行、安全，且具有伤口小、损伤轻、恢复快的优势。Objective To investigate the effect of the peritoneoscopic surgery for hydronephrosis caused by upper urinary tract obstruction, display its value in urinary surgery and summarize the operative experiences. Methods From Oct. 2005 to May 2009, 32 cases were treated by peritoneoscopic surgery. Among them, 19 cases were left side and 12 cases were right side,1 case was hibateral; 15 cases were male, 7 cases were female; the age is from 6 months to 13 years and 5 months with the mean age was 5 year 3 months. 20 cases were stenosis of the pyelourethero junction, 2 cases were aberrant blood vessel compression of the pyelourethero junction, 3 cases were polypus of nephric duct, 3 cases were renal pelvis and upper ureter calculus, 3 cases were gigantoureter caused by the stenosis of the extremity of the ureter. Results All operations were successful, 29 cases were from posterior cavum abdominis, 3cases were from abdominal cavity; 21 cases were pyeloureteroplasty, 3 cases were ablation of polypus of nephric duct and pyeloureteroplasty, 3 cases were ureterolithotomy, 1 case was mutilation of aberrant blood vessel, 3 cases were ureteral reimplantation. The operative time is from 60 to 260 mins, the mean time was 170 mins, and the mean bleed volume was 15 -20ml. With the fellow -up from 3 to 6 months after operation, all hydrops disappeared, the disjunction of the aggregation system was lessened by ultra- sonograph. In 8 cases, renal developing was accelerated and the ureter was unobstructed by IVU. 3 cases were no back flow by retrogradative opacifieation from bladder. Conclusion Peritoneoscopic surgery for pureile upper urinary tract obstruction is feasible and safe with the advantage of little damage and fast recovery, and the curative effect is as the same as open operation.

关 键 词：腹腔镜 肾积水 巨输尿管 儿童 

分 类 号：R691.2[医药卫生—泌尿科学]