腹腔镜联合输尿管软镜治疗肾盂输尿管连接部梗阻合并肾结石患儿的疗效分析  

Laparoscopic combined ureteroscopic treatment of renal pelvis ureter obstruction: Analysis of the curative effect of complicated kidney stone

作　　者：彭潜龙[1] 赵夭望[1] 田稳[1] 聂友能 刘李[1] 李创业 Peng Qianlong;Zhao Yaowang;Tian Wen;Nie Youneng;Liu Li;Li Chuangye(Department of Urology,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院泌尿外科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2020年第8期694-698,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省出生缺陷协同防治科技重大专项(编号:2019SK1010)。

摘　　要：目的探讨腹腔镜联合输尿管软镜治疗儿童肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)合并肾结石的安全性和有效性。方法回顾性分析2016年3月至2020年3月由湖南省儿童医院泌尿外科收治的13例UPJO合并肾结石的临床资料。所有病例均为多发结石,5例肾盂结石合并肾盏多发结石,其余8例为肾盏多发结石。其中左侧9例,右侧4例,均为单侧,结石直径为0.3~0.9 cm。术前均经泌尿系统B超和CT确诊。手术均采用三孔经腹腔途径入路,先按肾积水常规置入腹腔镜,显露扩张的肾盂后于肾盂近输尿管处做一小切口,通过腹腔镜Trocar置入输尿管软镜完成结石探查及碎石取石,最后腹腔镜下完成肾盂输尿管离断吻合术。观察手术时间、结石清除率、术中及术后并发症、手术效果,术后通过B超及CT检查进行随访。结果13例均一期完全清除结石及完成肾盂输尿管离断吻合术,无中转开放手术。手术时间90~118 min;术中出血量3~30 mL,无手术输血者。手术第2天进流食,术后住院时间5~7 d,平均6 d。术后随访8~18个月,平均12个月。术中及术后均未发生严重并发症,无结石残留,肾积水均有明显恢复甚至消退。结论腹腔镜联合输尿管镜治疗UPJO合并肾结石在不影响肾积水手术效果的前提下,明显增加了结石清除率。该手术方式具有创伤小、安全、恢复快、难度小等优点,且临床疗效满意。Objective To explore the safety and efficacy of laparoscopy plus soft ureteroscopy for renal pelvic and ureteropelvic junction obstruction(UPJO)with renal calculi.Methods From March 2016 to March 2020,clinical data were retrospectively analyzed for 13 cases of UPJO with renal calculi.There were pyelithiasis with multiple calyceal calculi(n=5)and multiple calyx calculi.The involved side was left(n=9)and right(n=4).The stone diameter was 0.3-0.9 cm.Preoperative diagnosis was made by ultrasound type B and computed tomography(CT).All operations were performed through a three-hole transperitoneal approach.Laparoscopy for hydronephrosis proceeded routinely by making a small incision near ureter of renal pelvis after exposing dilated renal pelvis.Laparoscopic Trocar of ureteroscopy and lithotripsy were performed.Finally ureteropelvic anastomosis was performed under laparoscopy.Operative duration,stone clearance rate,postoperative complications and operative outcomes were recorded.Color Doppler ultrasound and CT were employed for postoperative follow-ups.Results Complete removal of stones and complete rupture of ureteropelvic and renal pelvis have been performed without a transit open surgery.The operative duration was 90-118 min and the volume of blood loss 3-30 ml.There was no blood transfusion.A liquid diet resumed at Day 2 post-operation.The average postoperative hospital stay was 6(5-7)days.During an average follow-up period of 12(8-18)months,there were no serious postoperative complications.No residual stone was found.Hydronephrosis subsided obviously and even disappeared.Conclusion For UPJO with kidney stones without affecting the operative outcomes of hydronephrosis,laparoscopy plus ureteroscopy may significantly boost stone clearance rate.With minimal surgical trauma,it is safe,convenient and efficacious with a quick recovery.

关 键 词：肾结石/外科学 输尿管梗阻/外科学 腹腔镜 输尿管镜 儿童 

分 类 号：R692.4[医药卫生—泌尿科学] R691.2[医药卫生—外科学]