经结肠旁入路腹腔镜下肾盂输尿管成形术Anderson-Hynes  

Transperitoneal laparoscopic Anderson-Hynes pyeloplasty with transmesocolic access to the ureteropeivic junction obstruction

作　　者：何大维[1] 林涛[1] 魏光辉[1] 李旭良[1] 刘俊宏[1] 华燚[1] 刘丰[1] 

机构地区：[1]重庆医科大学附属儿童医院泌尿外科,400014

出　　处：《中华小儿外科杂志》2010年第7期502-505,共4页Chinese Journal of Pediatric Surgery

基　　金：国家“十一五”科技攻关项目支撑计划（编号：2006BA105A06）

摘　　要：目的 探讨经腹腔结肠旁腹腔镜下Anderson-Hynes肾盂输尿管成形术的技巧、安全性及适应证。方法2006年3月至2008年6月存我院采取经结肠系膜人路行Anderson—Hynes肾盂成形术32例，其中男18例，女14例。年龄8个月～16岁，平均年龄5．5岁。左侧17例，右侧11例，双侧4例。共36侧。肾盂输尿管连接处狭窄24侧，狭窄伴肾结石6侧（其中多发结石3例），输尿管息肉6侧。右侧经结肠肝曲对系膜缘，左侧经结肠系膜侧行Anderson—Hynes肾盂输尿管成形术，术后B超或IVU随访。结果30例顺利完成手术，学习期间中转开放2例（5．9％）。手术时间53～158min，单侧平均82min，双侧平均时间107min。术中失血15～40ml。术后双“J”管堵塞2例（6．3％）。1例多发结石术中残留结石1枚，在拔出双“J”管后，自行排出。术后随访6～26个月，无肾积水临床症状，影像学无梗阻及结石复发。结论经腹腔结肠旁入路腹腔镜下Anderson-Hynes肾盂输尿管成形术是一种安全、有效、微创的手术，而且容易学习，可以作为肾盂输尿管成形术首选术式，但是，在学习阶段，巨大肾积水、肾盂多发结石不宜首选该术式。Objective To evaluate the safety and outcome of transperitoneal laparoscopic pyeloplasty with a direct approach to the ureteropelvic junction obstruction （UPJO） through the mesenterocolic space. Methods Eighteen male and 14 female children were diagnosed with UPJO. Their ages ranged from 8 months to 16 years （mean, 5.5 years）. Thirty 8ix UPJO were found on the 32 patients, including 17 left unilateral PUJO, 11 right unilateral UPJO and 4 bilateral UPJO. All of them were treated with Anderson-Hynes transperitoneal laparoscopic dismembered pyeloplasty. Among the 36 UPJO, 24 UPJO were diagnosed as uretero pelvic junction stenosis 3 were complicated with single kidney calculi, 3 with multiple kidney calculi and 6 with ureteral polyps, Results Thirty patients underwent laparo scopic operations except 2 patients were transferred opening operations. The duration of operations ranged from 53 min to 158 min. Blood lose during operation was 15 to 40 ml. obstruction of double Jcatheter was noted on 2 patients（6.3%）. On one patient, residual stones were found after surgery, and were spontaneously expelled after double Jcatheter was removed. The patients were followed up for 6 to 26 months. No recurrence of obstruction and stone was noted. Conclusions Transmesenteric Anderson Hynes laparoscopie pyeloplasty is safe and effective for the treatment of UPJO.

关 键 词：腹腔镜外科手术 泌尿外科手术 肾盂输尿管连接处梗阻 

分 类 号：R699[医药卫生—泌尿科学]