经背部小切口入路离断式肾盂成形术治疗小婴儿UPJO的疗效观察  

Miniature pyeloplasty via a dorsal paravertebral transverse incision for infantile ureteropelvic junction obstruction

作　　者：刘伟[1] 杜国强[2] 张丽娟[1] 郭锋[1] 吴荣德[1] 张北叶 

机构地区：[1]山东大学附属省立医院小儿外科,济南250021 [2]山东省临沂市人民医院小儿外科 [3]台湾林口长庚医院小儿外科

出　　处：《中华小儿外科杂志》2015年第10期724-727,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的介绍经背部小切口入路离断式肾盂成形术治疗先天性。肾盂输尿管连接处梗阻（UPJO）所致肾积水的方法及疗效。方法2012年3月至2015年1月我科应用经背部小切口入路离断式肾盂成形术治疗40例UPJO患儿，SFU分级Ⅳ级，男33例，女7例，年龄1～12个月，其中左侧26例，右侧13例，双侧1例。术前B型超声检查示肾盂前后径2．7～5．8am。手术方法：患儿取俯卧位，取患侧背部12肋下1cm处脊柱外缘横切口，长约2．0cm，依次切开皮肤、皮下组织，纵向切开胸腰筋膜，沿腰大肌外缘向深部钝性分离，暴露患侧肾脏，经肾盂穿刺减压后，分离肾盂周围组织并将肾盂及UPJ部提出切口外进行操作，常规行Anderson-Hynes离断式肾盂成形术。术后常规行B型超声检查随访。结果本组40例患儿均顺利完成手术，梗阻原因均为。肾盂输尿管连接部狭窄所致，狭窄段长约o．5～2．5cm，术中放置双J管30例。手术时间50-70min术中出血10-20ml；术后4～5d出院。术后切口愈合好，无明显瘢痕，较美观。术后并发症3例：肾盂输尿管吻合口漏尿、吻合口梗阻、泌尿系感染各1例。术后随访6～39个月，所有患儿（包括并发症处理后患儿）术后B型超声随访检查肾积水较术前均有好转，肾皮质较术前增厚，肾盂前后径较术前减小。结论对于婴幼儿、。肾外型肾盂的UPJO患儿，经背部小切口入路为较好的微创方式，适于临床开展。Objective To evaluate the technique and clinical efficacy of adopting a dorsal paravertebral transverse incision for infantile ureteropelvic junction obstruction （UPJO）. Methods A total of 40 infants aged 1-12 months with large dilated pelvises underwent miniature pyeloplasty. Surgical access was gained through a 2. 0 cm dorsal paravertebral transverse muscle-splitting incision. After a meticulous dissection of ureteropelvic junction component, the affected section was extracted for classic dismembered pyeloplasty. Thirty of them had long-term stented anastomoses. Ultrasonographic follow-ups were conducted. Operative duration, hospital stay and complication rate were compared. Results Miniature pyeloplasty was successful in all patients. The overall operative duration had a range of 50-70 mira They were discharged after 4-5 days. Three major complications were anastomotic stricture （n = 1）, urinary infiltration （n = 1 ） and urinary infection （n = 1 ）. During a follow-up period of 6-39 months, postoperative radiological improvements were observed and all of them recovered from complications. Conclusions Miniature pyeloplasty via a small incision is both safe and effective in the treatment of UPJO in young infants with large renal pelvis.

关 键 词：肾积水 输尿管肾盂连接处梗阻 肾盂成形术 

分 类 号：R726.9[医药卫生—儿科]