单孔后腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部梗阻(附15例报告)  

Laparoendoscopic single-site retroperitoneal dismembered pyeloplasty:a report of 15 cases

作　　者：赖晨[1] 刘卫东[1] 陈湘[1] 杨中青[1] 陈志[1] 罗延诚[1] 谢超群[1] 李南南[1] 

机构地区：[1]中南大学湘雅医院泌尿外科,湖南长沙410008

出　　处：《中国内镜杂志》2013年第9期957-960,共4页China Journal of Endoscopy

摘　　要：目的探讨单孔后腹腔下离断式肾盂成形术治疗肾孟输尿管连接部梗阻（uPT0）的临床应用价值。方法2011年3月-2012年1月，经后腹腔途径实施单孔腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部梗阻15例。所有病例术前均经静脉肾盂造影（Ivu）、磁共振水成像和（或）逆行肾孟造影诊断。结果成功实施13例单孔后腹腔镜下离断式肾盂成形术，1例因损伤腹膜导致手术操作空间受限而转为腹腔镜。平均手术时间149．3min（103—220min），术中出血量31．3mL（10～70mL），平均术后住院天数5．6d（3—13d）。1例术后漏尿并通过保守治疗治愈，平均随访4．6个月（3～8个月）。术后3个月后复查IVU及B超均显示肾孟积水减小、尿路通畅。结论单孔后腹腔镜下离断式肾盂成形术安全、有效，美容效果显著，具有较好的临床应用价值。[ Objective ] To investigate the clinical application of laparoendoscopic single-site retroperitoneal dismembered pyeloplasty. [Methods] 15 cases with UPJO were treated by laparoendoscopic single-site retroperi- toneal dismembered pyeloplasty. The diagnosis was established by renal uhrasonography, intravenous urography （IVU） with high-volume contrast medium, magnetic resonance urography and/or retrograde pyelography. [Result] Laparoendoscopic single-site retroperitoneal dismembered pyeloplasty was successful in 14 patients, while 1 case required 4-port retroperitoneoscopic conversion because of difficulties in remaining the retroperitoneal space due to peritoneal tear during the procedure. The mean operative time was 149.3 minutes （range 103.0-220.0 min）. The mean estimated blood loss was 31 mL （range 10-70 mL）, and the mean postoperative hospital stay was 5.6 days （range 3-13 d）. Intraoperative complications were limited to 1 cases of peritoneal tear. Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management. The mean foUow-up period was 4.6 months （range 3 to 8 months）. Satisfactory drainage with decreased hydronephrosis on IVU and renal uhrasonog- raphy was considered successful in all cases at the 3-month imaging studies. [Conclusion] Laparoendoscopic sin- gle-site retroperitoneal dismembered pyeloplasty is a feasible, safe and effective procedure for correcting UPJ ob- struction, offering improved cosmesis.

关 键 词：肾盂输尿管连接部梗阻 单孔后腹腔镜 离断式肾盂成形术 

分 类 号：R617[医药卫生—外科学]