经腹膜外(后腹腔)途径腹腔镜离断性肾盂成形术治疗肾盂输尿管连接部梗阻的疗效分析(附37例报告)  

The effect of dismembered pyeloplasty by retroperitoneal laparoscopy for ureteropelvic junction obstruction: with a report of 37 cases

作　　者：曲发军[1] 叶剑青[1] 崔心刚[1] 高轶[1] 徐丹枫[1] 

机构地区：[1]上海长征医院,上海200003

出　　处：《腹腔镜外科杂志》2015年第11期818-820,共3页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金资助项目资助(编号:81170637);上海市科委科研计划项目课题资助(编号:11JC1402302)

摘　　要：目的:评价后腹腔镜离断性肾盂成形术治疗肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)的临床疗效。方法:行后腹腔镜离断性肾盂成形术治疗37例UPJO患者。采用3切口建立后腹腔操作空间,术中适当游离肾下极,显露肾盂输尿管连接部与UPJO处。术中根据情况行纤维束带松解、肾盂裁剪、输尿管狭窄段切除与肾盂输尿管再吻合等步骤,吻合完成前经吻合口放置双J管。结果:除1例患者因肾周严重粘连而中转开放手术外,其余患者均成功行腹腔镜手术。术中无严重并发症发生。术后平均随访(18.0±2.1)个月。32例患者临床症状缓解或消失,影像学检查提示肾积水好转。5例患者肾积水未缓解,其中1例后期再次开放手术行狭窄段切除+吻合术,3例留置双J管并定期更换,1例后期行无功能肾切除术。结论:此术式需要一定的学习曲线,疗效确切,且具有微创手术的优点,正逐步取代开放手术成为治疗UPJO的首选方法。Objective： To evaluate the therapeutic effect of retroperitoneal laparoscopic dismembered pyeloplasty on ureteropelvic junction obstruction（ UPJO）. Methods： A total of 37 patients with UPJO underwent retroperitoneal laparoscopic dismembered pyeloplasty. Three Trocars were put in corresponding location to build operative space. Inferior pole of kidney was freed properly to show the junction of ureter and renal pelvis. During the operation,essential procedures were operated,such as relieving fiber belt,clipping renal pelvis,excising stenosis segment,anastomosing ureteropelvic junction and so on. Before the completion of anastomosis,a double-J stent was put into the ureter through stoma. Results： All the laparoscopic operations were performed successfully except one case undergoing conversion to open operation because of serious adhesions around kidney. No severe complication occurred during operations.（ 18. 0 ±2. 1） months of post-operative follow-up assessment were done. 32 patients got relief of clinical symptoms and radiologic improvement.5 cases underwent ureteral stent implantation（ three cases） or open operation（ one case of secondary anastomosis and one case of nephrectomy） because of poor operation effect. Conclusions： A certain learning curve is needed for mastering the operation. This mini-invasive operation has good therapeutic effect for UPJO,and will become the preferred treatment for UPJO instead of open surgery.

关 键 词：肾盂输尿管连接部梗阻 离断性肾盂成形术 腹腔镜检查 腹膜后途径 

分 类 号：R699[医药卫生—泌尿科学]