腹腔镜下肾盂成形术治疗UPJO的技术改良与实践  

Technical improvement and practice of laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction(UPJO)

作　　者：伍国豪 张志华 张廷顺 胡先国 吴炳权[3] 赖彩永[1] Wu Guohao;Zhang Zhihua;Zhang Tingshun;Hu Xianguo;Wu Bingquan;Lai Caiyong(Department of Urology,The First Affiliated Hospital of Jinan Universtity,Guangzhou 510632,China;Department of Urology,Yangxi County People's Hospital,Yangjiang 529800,China;Department of Urology,The First People's Hospital of Zhaoqing,Zhaoqing 526000,China)

机构地区：[1]暨南大学附属第一医院泌尿外科,广州510632 [2]阳西县人民医院泌尿外科,阳江529800 [3]肇庆市第一人民医院泌尿外科,526000

出　　处：《国际医药卫生导报》2021年第2期202-207,共6页International Medicine and Health Guidance News

基　　金：阳江市医疗卫生类科技计划项目(2018126)。

摘　　要：目的探讨层面外科技术、不全裁剪及全程无钳夹缝合等技术在腹腔镜肾盂成形术(laparoscopic pyeloplasty,LP)中治疗UPJO的应用和疗效。方法回顾性分析暨南大学附属第一医院及肇庆市第一人民医院2014年1月至2019年12月期间对37例患者由同一位医师完成的LP治疗的临床资料,术中采用层面外科分离显露技术,不全斜形离断方法裁剪肾盂输尿管狭窄段,完成最低点的第一针缝合后,离断狭窄段组织作为牵引段,全程采用细针无钳夹缝合。手术治疗成功标准为:疼痛症状消失、肾积水减轻,肾功能好转或稳定在一定水平。结果37例手术均获成功,无一例中转开放手术,手术时间范围90~416 min,手术时间(228.28±69.86)min;术中失血量范围15~300 ml,术中失血量(60.14±58.39)ml;术后住院时间范围4~23 d,术后住院时间(9.41±4.36)d;术后随访3~60个月,平均随访34个月;1例患者拔除双J管后反复出现腰部疼痛,予重新留置双J管后症状缓解,手术成功率97.3%(36/37)。结论层面外科技术、不全裁剪及全程无钳夹缝合等技术在腹腔镜肾盂成形术中治疗UPJO操作稳定、安全可行、成功率高,值得进一步推广和应用。Objective To research the application and efficacy of using sectional surgical technique,incomplete dismemberment,and whole-process suture without clamp in laparoscopic pyeloplasty(LP)for the treatment of ureteropelvic junction obstruction(UPJO).Methods The clinical data of 37 patients with UPJO who have undergone LP by the same surgeon in The First Affiliated Hospital of Jinan Universtity and The First People's Hospital of Zhaoqing between January 2014 and December 2019 were retrospectively analyzed.During the operation,the technique of sectional surgical separation and exposure and incomplete oblique dismemberment were used to cut the ureteropelvic junction.After the first stitch of the lowest point was completed,with the separated ureteropelvic junction tissue as pull segment,whole-process suture with fine needle without clamp was implemented.The criteria of successful surgical treatment were as follows:pain disappeared,hydronephrosis relieved,renal function improved or stabilized at a certain level.Results The operation of 37 cases were all proved successful. No cases required conversion toopen surgery. The operative time was 90~416 min with the average of (228.28±69.86) min. Theintraoperative blood loss was 15~300 ml with the average of (60.14±58.39) ml. The postoperativehospital stay was 4~23 days with the average of (9.41±4.36) days. The follow-up time was 3-60months with the average of 34.0 months. One patient suffered from recurrent flank pain after theremoval of double-J stent, and the symptom was relieved after the double-J stent was retained again.The success rate of surgery was 97.3% (36/37). Conclusion Sectional surgical technique,incomplete dismemberment, and whole-process suture without clamp in laparoscopic pyeloplastyfor the treatment of UPJO are safe and feasible, with high success rate. Therefore, it is worthy offurther promotion and application.

关 键 词：腹腔镜肾盂成形术 技术改良 肾盂输尿管连接部梗阻 

分 类 号：R699.2[医药卫生—泌尿科学]